Provider Demographics
NPI:1801389010
Name:LA BONTE, AMANDA ELAINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:LA BONTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 NE ELLIOTT CIR UNIT 91
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9414
Mailing Address - Country:US
Mailing Address - Phone:541-286-7660
Mailing Address - Fax:
Practice Address - Street 1:1035 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2505
Practice Address - Country:US
Practice Address - Phone:360-425-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR398512225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist