Healthcare Provider Details

I. General information

NPI: 1336763184
Provider Name (Legal Business Name): AMANDA KUCHERA MSOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3599 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4252
US

IV. Provider business mailing address

7 ELENA CT
MEDFORD NJ
08055-9175
US

V. Phone/Fax

Practice location:
  • Phone: 904-345-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61036956
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: