Provider Demographics
NPI:1528464625
Name:GATES, AMANDA ELISE (OTR, CHT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELISE
Last Name:GATES
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8321
Mailing Address - Country:US
Mailing Address - Phone:850-995-1364
Mailing Address - Fax:
Practice Address - Street 1:3650 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8321
Practice Address - Country:US
Practice Address - Phone:850-995-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12484225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand