Provider Demographics
NPI:1588144844
Name:SHARP, AMANDA NICHOLE (COTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICHOLE
Last Name:SHARP
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 1:224 REIERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2925
Mailing Address - Country:US
Mailing Address - Phone:903-681-2587
Mailing Address - Fax:
Practice Address - Street 1:809 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:KERENS
Practice Address - State:TX
Practice Address - Zip Code:75144-2715
Practice Address - Country:US
Practice Address - Phone:903-396-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211368224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant