=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457233728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA BEMIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2025
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 INTERCHANGE RD
-----------------------------------------------------
City | KRESGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18333-7704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 272-639-5350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 N BROAD ST
-----------------------------------------------------
City | NAZARETH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18064-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OP10330
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------