Healthcare Provider Details

I. General information

NPI: 1790154805
Provider Name (Legal Business Name): AMANDA BARSTOW MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 JAMES RD STE 300
GRANBURY TX
76049-3123
US

IV. Provider business mailing address

2245 SUNFISH PT
BLUFF DALE TX
76433-4391
US

V. Phone/Fax

Practice location:
  • Phone: 817-910-8131
  • Fax:
Mailing address:
  • Phone: 402-382-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1784
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: