Healthcare Provider Details

I. General information

NPI: 1265713788
Provider Name (Legal Business Name): AMY EGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

184 HIGH ST STE 701
BOSTON MA
02110-3025
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-8000
  • Fax:
Mailing address:
  • Phone: 800-337-5965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: