Individual
AMANDA GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
340 TESCONI CIR STE C, SANTA ROSA, CA 95401-4676
(707) 546-9160
Mailing address
340 TESCONI CIR STE C, SANTA ROSA, CA 95401-4676
(707) 546-9160
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225X00000X
Occupational Therapist
OT5383
CA
225XP0200X
Pediatric Occupational Therapist
Primary
OT5383
CA
Other
Enumeration date
05/16/2007
Last updated
10/24/2012
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