Provider Demographics
NPI:1861258436
Name:FIELDS, AMANDA (COTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 PRAIRE HILLS DR.
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089
Mailing Address - Country:US
Mailing Address - Phone:404-823-8039
Mailing Address - Fax:
Practice Address - Street 1:1824 COMMONS CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9537
Practice Address - Country:US
Practice Address - Phone:405-467-6782
Practice Address - Fax:405-467-6100
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1280224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant