Provider Demographics
NPI:1922989789
Name:BARD, AMANDA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BARD
Suffix:
Gender:X
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MAIN ST # 3B
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1064
Mailing Address - Country:US
Mailing Address - Phone:203-828-6790
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST # 3B
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1064
Practice Address - Country:US
Practice Address - Phone:203-828-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist