Healthcare Provider Details

I. General information

NPI: 1164549259
Provider Name (Legal Business Name): AMANDA DIGIOVANNI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 WOODLAKE DR
MARLTON NJ
08053-3617
US

IV. Provider business mailing address

97 WOODLAKE DR
MARLTON NJ
08053-3617
US

V. Phone/Fax

Practice location:
  • Phone: 856-745-6411
  • Fax:
Mailing address:
  • Phone: 856-373-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00301900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: