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General NPI Number Information
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NPI Number | 1053600023
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Entity Type | Individual
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Provider Name | AMANDA NEGLIA TIETZER
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Gender | Female
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 8 JOHNSON ST
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City | STATEN ISLAND
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State | NY
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Zip | 10309-1148
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Country | US
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Telephone | 718-979-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 231 NOEL ST
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6072
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Country | US
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Telephone |
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Fax |
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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 | 016666
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License Number State | NY
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