Provider Demographics
NPI:1366755332
Name:KEARON, AMELIA (COTA/L)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:KEARON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:A.
Other - Middle Name:
Other - Last Name:WALLENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:399 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:NH
Mailing Address - Zip Code:03278-4208
Mailing Address - Country:US
Mailing Address - Phone:603-848-5929
Mailing Address - Fax:
Practice Address - Street 1:325 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:BOSCAWEN
Practice Address - State:NH
Practice Address - Zip Code:03303-2410
Practice Address - Country:US
Practice Address - Phone:603-848-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0544224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant