Provider Demographics
NPI:1114426210
Name:BISOGNI, AMY (OTR/L, CNT, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BISOGNI
Suffix:
Gender:F
Credentials:OTR/L, CNT, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 RAMONA DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8431
Mailing Address - Country:US
Mailing Address - Phone:310-422-3744
Mailing Address - Fax:
Practice Address - Street 1:1555 RAMONA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8431
Practice Address - Country:US
Practice Address - Phone:310-422-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-306419174N00000X
CA14695225XF0002X, 225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics