Provider Demographics
NPI:1811218977
Name:FORTIER, AMANDA DORIS (MS OT R/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DORIS
Last Name:FORTIER
Suffix:
Gender:F
Credentials:MS OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1046 OKUPE ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3552
Mailing Address - Country:US
Mailing Address - Phone:207-522-2859
Mailing Address - Fax:
Practice Address - Street 1:89-195 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-4102
Practice Address - Country:US
Practice Address - Phone:808-696-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist