Provider Demographics
NPI:1801330337
Name:DIBLASI, AMANDA ROSE (COTA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ROSE
Last Name:DIBLASI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LOVELL ROAD
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885
Mailing Address - Country:US
Mailing Address - Phone:631-704-3824
Mailing Address - Fax:
Practice Address - Street 1:134 NORTH ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1315
Practice Address - Country:US
Practice Address - Phone:978-276-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant