Healthcare Provider Details

I. General information

NPI: 1225134257
Provider Name (Legal Business Name): AMY ROBENA UMANSKY OT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BRISTOL ST SUITE 180
COSTA MESA CA
92626-1808
US

IV. Provider business mailing address

3200 BRISTOL ST SUITE 180
COSTA MESA CA
92626-1808
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-9292
  • Fax: 714-557-9137
Mailing address:
  • Phone: 714-557-9292
  • Fax: 714-557-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 5983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: