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General NPI Number Information
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NPI Number | 1801389010
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Entity Type | Individual
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Provider Name | AMANDA ELAINE LA BONTE OTD, OTR/L, BCG
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 12/22/2024
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Provider Practice Location Address
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Address Line | 300 MULLINS DR
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City | LEBANON
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State | OR
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Zip | 97355-4054
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Country | US
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Telephone | 541-918-8832
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 RIVER RD S APT D
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City | SALEM
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State | OR
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Zip | 97302-9301
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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 | 398512
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License Number State | OR
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