Individual
AMANDA A WILDBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
30941 MILL LN, SUITE D, SPANISH FORT, AL 36527-5456
(251) 625-2170
(251) 625-2172
Mailing address
1908 FLINT RD SE, DECATUR, AL 35601-6031
(256) 340-9708
(256) 340-9624
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3282
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003819608
GROUP NPI
AL
05
—
529917620
—
AL
Enumeration date
06/16/2011
Last updated
08/06/2012
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