Provider Demographics
NPI:1144898248
Name:ESCAMILLA, AMY BETH (COTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:FUNKHOUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:6720 28TH ST APT 508
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2869
Mailing Address - Country:US
Mailing Address - Phone:806-777-8126
Mailing Address - Fax:
Practice Address - Street 1:6640 IOLA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7845
Practice Address - Country:US
Practice Address - Phone:806-687-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
TX214007224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant