Healthcare Provider Details

I. General information

NPI: 1710718259
Provider Name (Legal Business Name): AMANDA TIARA GOMEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8254 233RD ST
BELLEROSE MANOR NY
11427-2114
US

IV. Provider business mailing address

8254 233RD ST
BELLEROSE MANOR NY
11427-2114
US

V. Phone/Fax

Practice location:
  • Phone: 646-671-0088
  • Fax:
Mailing address:
  • Phone: 646-671-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number028909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: