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General NPI Number Information
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NPI Number | 1265792725
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Entity Type | Individual
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Provider Name | AMANDA M POUMAKIS
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Gender | Female
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 1200 W STATE ROAD 434 STE 220
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City | LONGWOOD
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State | FL
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Zip | 32750-4958
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Country | US
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Telephone | 407-389-0036
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CONCORD COACH DR
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City | SALEM
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State | NH
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Zip | 03079-4013
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Country | US
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Telephone | 603-275-0491
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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 | 10404
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License Number State | MA
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