Individual
AMANDA GIBSON SOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA OTR/L
Contact information
Practice address
2999 CLEVELAND AVE, SANTA ROSA, CA 95403-2761
(707) 546-9160
(707) 546-1338
Mailing address
2999 CLEVELAND AVE, SANTA ROSA, CA 95403-2761
(707) 546-9160
(707) 546-1338
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT9336
CA
225XP0200X
Pediatric Occupational Therapist
Primary
OT9336
CA
Other
Enumeration date
02/23/2009
Last updated
02/23/2009
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