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NPI Code Detail

MEDICARE: MRS. AMANDA FULFORD COTA/L

MEDICARE: MRS. AMANDA FULFORD COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant03978OH

General Provider Information

NPI Number : 1548904303
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA FULFORD COTA/L
Provider Business Mailing Address
First Line : 810 N PROSPECT ST
Second Line :
City : BOWLING GREEN
State : OH
Zip : 43402-1821
Country : US
Telephone Number : 419-308-6057
Fax Number :
Provider Business Practice Location Address
First Line : 20311 PEMBERVILLE RD
Second Line :
City : PEMBERVILLE
State : OH
Zip : 43450-9413
Country : US
Telephone Number : 419-833-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2022
Last Update Date : 04/26/2022

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