Provider Demographics
NPI:1225134257
Name:UMANSKY, AMY ROBENA (OT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ROBENA
Last Name:UMANSKY
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BRISTOL ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1808
Mailing Address - Country:US
Mailing Address - Phone:714-557-9292
Mailing Address - Fax:714-557-9137
Practice Address - Street 1:3200 BRISTOL ST
Practice Address - Street 2:SUITE 180
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1808
Practice Address - Country:US
Practice Address - Phone:714-557-9292
Practice Address - Fax:714-557-9137
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT 5983OtherOT LICENSE
CAOT 5983OtherOT LICENSE