Provider Demographics
NPI:1376807057
Name:STAPLES, AMANDA M (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:STAPLES
Suffix:
Gender:F
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 1:343 STEDMAN PL
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2169
Mailing Address - Country:US
Mailing Address - Phone:626-388-7018
Mailing Address - Fax:
Practice Address - Street 1:1740 HUNTINGTON DR STE 301
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3848
Practice Address - Country:US
Practice Address - Phone:626-388-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7362225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics