Healthcare Provider Details

I. General information

NPI: 1568007490
Provider Name (Legal Business Name): AMANDA GEURTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GARDEN RD
MONTEREY CA
93940-5373
US

IV. Provider business mailing address

472 REINDOLLAR AVE
MARINA CA
93933-3733
US

V. Phone/Fax

Practice location:
  • Phone: 831-250-6770
  • Fax:
Mailing address:
  • Phone: 831-869-8945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: