Provider Demographics
NPI:1063933224
Name:VAUGHAN, AMANDA (COTA/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:932 CADMAN DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 S 6TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:DE
Practice Address - Zip Code:19730-2060
Practice Address - Country:US
Practice Address - Phone:302-376-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0012241224Z00000X
NY009045-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant