Provider Demographics
NPI:1992136030
Name:HALL, AMANDA KAY (OT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:HALL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751274
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1274
Mailing Address - Country:US
Mailing Address - Phone:919-620-4700
Mailing Address - Fax:
Practice Address - Street 1:801 W BARBEE CHAPEL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8188
Practice Address - Country:US
Practice Address - Phone:919-385-4904
Practice Address - Fax:919-385-4905
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant