Provider Demographics
NPI:1316628019
Name:HARRIS, AMANDA SHAYNNE (COTA/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SHAYNNE
Last Name:HARRIS
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 1:1316 HONEYSUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-3228
Mailing Address - Country:US
Mailing Address - Phone:314-795-3446
Mailing Address - Fax:
Practice Address - Street 1:1316 HONEYSUCKLE CT
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-3228
Practice Address - Country:US
Practice Address - Phone:314-795-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023020889224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant