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General NPI Number Information
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NPI Number | 1164812053
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Entity Type | Individual
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Provider Name | AMANDA SUZANNE MARTIN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1518 JADWIN AVE
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City | RICHLAND
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State | WA
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Zip | 99354-2902
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Country | US
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Telephone | 509-942-8474
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Fax |
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Provider Business Mailing Address
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Address Line | 5914 RAMUS LN
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City | PASCO
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State | WA
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Zip | 99301-8080
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Country | US
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Telephone | 208-360-0378
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | TL60536271
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License Number State | WA
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