Provider Demographics
NPI:1932259017
Name:KOTOLSKI, AMANDA MARIE (PHD, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:KOTOLSKI
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 BAHIA DEL MAR BLVD
Mailing Address - Street 2:207
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-3321
Mailing Address - Country:US
Mailing Address - Phone:727-637-6137
Mailing Address - Fax:727-388-9640
Practice Address - Street 1:6061 BAHIA DEL MAR BLVD
Practice Address - Street 2:207
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-3321
Practice Address - Country:US
Practice Address - Phone:727-637-6137
Practice Address - Fax:727-388-9640
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL743501OtherUHC OPTUM HEALTH
FL891186000Medicaid
FL190029OtherBLUE CROSS BLUE SHIELD
FL812350100Medicaid
Z113TOtherBCBS FL
FL812350100Medicaid
FL891186000Medicaid
Z113TOtherBCBS FL