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General NPI Number Information
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NPI Number | 1942189691
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Entity Type | Individual
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Provider Name | MRS. AMANDA BERG KERSHAW
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1875 E GUADALUPE RD
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City | TEMPE
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State | AZ
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Zip | 85283-3287
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Country | US
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Telephone | 480-777-8466
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Fax |
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Provider Business Mailing Address
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Address Line | 938 E CONCORDA DR
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City | TEMPE
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State | AZ
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Zip | 85282-2418
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Country | US
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Telephone | 480-968-6246
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Fax | 480-968-6246
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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 | OTH-010042
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License Number State | AZ
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