Healthcare Provider Details

I. General information

NPI: 1548178890
Provider Name (Legal Business Name): AMANDA MOYER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 STADIUM DR
KALAMAZOO MI
49009-4943
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 269-737-6455
  • Fax:
Mailing address:
  • Phone: 616-840-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014777
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: