Provider Demographics
NPI:1043714272
Name:BEZERRA-RICHTER, AMANDA FRANCO (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FRANCO
Last Name:BEZERRA-RICHTER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:FRANCO
Other - Last Name:BEZERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST RM 308
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-6005
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022316-1225XP0200X, 225X00000X
NY022316225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics