Provider Demographics
NPI:1356102362
Name:EUGENIO, AMANDA (OT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:EUGENIO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1830
Mailing Address - Country:US
Mailing Address - Phone:818-369-7700
Mailing Address - Fax:818-369-7702
Practice Address - Street 1:1218 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1830
Practice Address - Country:US
Practice Address - Phone:818-369-7700
Practice Address - Fax:818-369-7702
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist