Individual
MRS. AMANDA FULFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
20311 PEMBERVILLE RD, PEMBERVILLE, OH 43450-9413
(419) 833-7000
Mailing address
810 N PROSPECT ST, BOWLING GREEN, OH 43402-1821
(419) 308-6057
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
03978
OH
Other
Enumeration date
04/26/2022
Last updated
04/26/2022
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