Provider Demographics
NPI:1104287390
Name:SCOTT, AMANDA LEIGH (LMT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEIGH
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8761 FURMAN MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460
Mailing Address - Country:US
Mailing Address - Phone:607-244-5339
Mailing Address - Fax:
Practice Address - Street 1:409 COUNTY RD 33
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-334-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028949-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist