Provider Demographics
NPI:1588909675
Name:RICHARDSON, AMY L (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22035 BURBANK BLVD APT 136
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4741
Mailing Address - Country:US
Mailing Address - Phone:508-446-7018
Mailing Address - Fax:
Practice Address - Street 1:22035 BURBANK BLVD
Practice Address - Street 2:APT 136
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-4737
Practice Address - Country:US
Practice Address - Phone:505-446-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2677224Z00000X
MA2541224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant