MEDICARE: MRS. AMANDA LYNNETTE HAMBEL 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
1	101Y00000X	Counselor	175264	OH
2	104100000X	Social Worker	S.2005703	OH
3	224Z00000X	Occupational Therapy Assistant	2622	OH

General Provider Information

NPI Number	:	1619215498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LYNNETTE HAMBEL COTA/L

Provider Business Mailing Address
First Line	:	9769 MARIETTA RD SE
Second Line	:
City	:	NEW LEXINGTON
State	:	OH
Zip	:	43764-9101
Country	:	US
Telephone Number	:	740-342-1737
Fax Number	:

Provider Business Practice Location Address
First Line	:	9769 MARIETTA RD SE
Second Line	:
City	:	NEW LEXINGTON
State	:	OH
Zip	:	43764-9101
Country	:	US
Telephone Number	:	740-342-1737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	12/17/2020

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