Provider Demographics
NPI:1538500673
Name:GARRIS, AMY LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:GARRIS
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 1:74 E 5TH AVE
Mailing Address - Street 2:APT #K304
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2365
Mailing Address - Country:US
Mailing Address - Phone:716-450-7798
Mailing Address - Fax:
Practice Address - Street 1:74 E 5TH AVE
Practice Address - Street 2:APT #K304
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2365
Practice Address - Country:US
Practice Address - Phone:716-450-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006902224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant