Provider Demographics
NPI:1922606797
Name:KLEIST, AMANDA (OTR/L)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:KLEIST
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 1:1091 NE ORENCO STATION PKWY APT E306
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-4438
Mailing Address - Country:US
Mailing Address - Phone:208-914-0773
Mailing Address - Fax:
Practice Address - Street 1:1425 N KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4541
Practice Address - Country:US
Practice Address - Phone:503-575-9402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR443037225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics