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General NPI Number Information
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NPI Number | 1003100611
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Entity Type | Individual
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Provider Name | AMANDA TRISTAN OT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 1101 SW 122ND AVE APT 113
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City | MIAMI
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State | FL
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Zip | 33184-2808
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Country | US
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Telephone | 786-281-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 5920 SW 68TH ST
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3524
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Country | US
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Telephone | 305-665-0886
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Fax | 305-667-4349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 16770
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License Number State | FL
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