MEDICARE: AMANDA J GRETSCH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT6359	CA

General Provider Information

NPI Number	:	1164785804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA J GRETSCH, INC.

Provider Business Mailing Address
First Line	:	PO BOX 236049
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92023-6049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5402 RUFFIN RD STE 104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1319
Country	:	US
Telephone Number	:	760-525-3111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OCCUPATIONAL THERAPIST
Name	:	AMANDA GRETSCH
Credential	:	O.T.R./L.
Telephone Number	:	760-525-3111

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	06/18/2012

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