Healthcare Provider Details

I. General information

NPI: 1457233728
Provider Name (Legal Business Name): AMANDA BEMIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 INTERCHANGE RD
KRESGEVILLE PA
18333-7704
US

IV. Provider business mailing address

24 N BROAD ST
NAZARETH PA
18064-1501
US

V. Phone/Fax

Practice location:
  • Phone: 272-639-5350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP10330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: