Provider Demographics
NPI:1194971119
Name:SEBASTIAN, AMY R (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:SEBASTIAN
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 1:5616 WRANGLER WAY
Mailing Address - Street 2:
Mailing Address - City:BOOMER
Mailing Address - State:NC
Mailing Address - Zip Code:28606-9625
Mailing Address - Country:US
Mailing Address - Phone:828-754-0631
Mailing Address - Fax:
Practice Address - Street 1:2030 HARPER AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4953
Practice Address - Country:US
Practice Address - Phone:828-754-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-10
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant