Provider Demographics
NPI:1396425229
Name:KIRCHGESNER, AMANDA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:KIRCHGESNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 OLD COTTAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8494
Mailing Address - Country:US
Mailing Address - Phone:904-404-6823
Mailing Address - Fax:
Practice Address - Street 1:59 OLD COTTAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-8494
Practice Address - Country:US
Practice Address - Phone:904-404-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14603224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant