Healthcare Provider Details

I. General information

NPI: 1639510316
Provider Name (Legal Business Name): AMANDA HOLLAND MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 SHARLOH LOOP
BISMARCK ND
58501-7772
US

IV. Provider business mailing address

1413 SHARLOH LOOP
BISMARCK ND
58501-7772
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1290
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: