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NPI Code Detail

MEDICARE: AMANDA JOAN PRINE OTRL

MEDICARE: AMANDA JOAN PRINE OTRL
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
1225XP0200XPediatric Occupational Therapist2000175710MO
2225XP0200XPediatric Occupational Therapist8885CA

General Provider Information

NPI Number : 1356311047
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA JOAN PRINE OTRL
Provider Business Mailing Address
First Line : 3638 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-5702
Country : US
Telephone Number : 310-204-8999
Fax Number : 310-204-8916
Provider Business Practice Location Address
First Line : 3638 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-5702
Country : US
Telephone Number : 310-204-8999
Fax Number : 310-204-8916
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 07/08/2007

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Directions to “ AMANDA JOAN PRINE OTRL” Practice Location

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