Healthcare Provider Details

I. General information

NPI: 1851151500
Provider Name (Legal Business Name): AMANDA ELAINE LADD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W ADAMS ST STE 3407
PHOENIX AZ
85007-2662
US

IV. Provider business mailing address

1740 W ADAMS ST STE 3407
PHOENIX AZ
85007-2662
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-4565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009577
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: