Individual
AMANDA MICHELLE AYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1930 S BROAD ST, PHILADELPHIA, PA 19145-2328
(267) 570-5342
Mailing address
523 W BUTLER ST, PHILADELPHIA, PA 19140-3330
(904) 655-8478
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP007456
PA
Other
Enumeration date
07/30/2013
Last updated
07/30/2013
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