Provider Demographics
NPI:1265991400
Name:ROBERTSON, AMANDA LEE (COTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEE
Last Name:ROBERTSON
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 1:6826 VIOLET DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6291
Mailing Address - Country:US
Mailing Address - Phone:540-604-4831
Mailing Address - Fax:
Practice Address - Street 1:12371 COTTAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7844
Practice Address - Country:US
Practice Address - Phone:804-363-7214
Practice Address - Fax:804-798-5279
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002130224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant