Healthcare Provider Details

I. General information

NPI: 1073838124
Provider Name (Legal Business Name): AMELIA JACKERSON LEVY M.ED, MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 PARK DALE LN
ENCINITAS CA
92024-4324
US

IV. Provider business mailing address

420 GLEN ARBOR DR
ENCINITAS CA
92024-1926
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-4344
  • Fax:
Mailing address:
  • Phone: 310-741-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: