Provider Demographics
NPI:1023997822
Name:GILBERT, AMANDA LEIGH (COTA/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:GILBERT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 LOCH TANNA LOOP
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5483
Mailing Address - Country:US
Mailing Address - Phone:864-608-2621
Mailing Address - Fax:
Practice Address - Street 1:1248 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4699
Practice Address - Country:US
Practice Address - Phone:904-264-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA19611224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant