Healthcare Provider Details

I. General information

NPI: 1376807057
Provider Name (Legal Business Name): AMANDA M STAPLES MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E FOOTHILL BLVD STE 200
ARCADIA CA
91006-2335
US

IV. Provider business mailing address

343 STEDMAN PL
MONROVIA CA
91016-2169
US

V. Phone/Fax

Practice location:
  • Phone: 626-388-7018
  • Fax:
Mailing address:
  • Phone: 626-388-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: