Healthcare Provider Details

I. General information

NPI: 1932259017
Provider Name (Legal Business Name): AMANDA MARIE KOTOLSKI PH.D, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 BAHIA DEL MAR BLVD 207
ST PETERSBURG FL
33715-3321
US

IV. Provider business mailing address

6061 BAHIA DEL MAR BLVD 207
ST PETERSBURG FL
33715-3321
US

V. Phone/Fax

Practice location:
  • Phone: 727-637-6137
  • Fax: 727-388-9640
Mailing address:
  • Phone: 727-637-6137
  • Fax: 727-388-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: