Provider Demographics
NPI:1902092778
Name:ERBEN, AMANDA KOHR (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KOHR
Last Name:ERBEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEA
Other - Last Name:KOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 27TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4328
Mailing Address - Country:US
Mailing Address - Phone:850-319-3512
Mailing Address - Fax:
Practice Address - Street 1:636 ATTERDAG RD
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463
Practice Address - Country:US
Practice Address - Phone:805-686-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20603225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist