Healthcare Provider Details

I. General information

NPI: 1275014326
Provider Name (Legal Business Name): AMANDA MICHELLE JORDAN BSN, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E ROMIE LN
SALINAS CA
93901-4208
US

IV. Provider business mailing address

1884 HARTFORD ST
SALINAS CA
93906-4812
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-8072
  • Fax:
Mailing address:
  • Phone: 831-737-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: