Healthcare Provider Details

I. General information

NPI: 1841858057
Provider Name (Legal Business Name): AMIVI AMEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 03/13/2023
Certification Date: 03/11/2023
Deactivation Date: 03/06/2023
Reactivation Date: 03/10/2023

III. Provider practice location address

5215 W CEDAR LN
BETHESDA MD
20814-1548
US

IV. Provider business mailing address

9709 KEY WEST AVE APT 331
ROCKVILLE MD
20850-4515
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-5500
  • Fax:
Mailing address:
  • Phone: 301-367-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: