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General NPI Number Information
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NPI Number | 1659901197
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Entity Type | Individual
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Provider Name | AMANDA RENEE LORD OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1001 SNEATH LN STE 200
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City | SAN BRUNO
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State | CA
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Zip | 94066-2349
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Country | US
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Telephone | 916-382-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 20 LEO ST APT 2
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City | SAN FRANCISCO
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State | CA
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Zip | 94112-2773
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Country | US
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Telephone | 707-430-3755
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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 | OT16161
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License Number State | CA
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