Provider Demographics
NPI:1538229950
Name:GRETSCH, AMANDA JANE (OTR)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:GRETSCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 ENCINITAS BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3744
Mailing Address - Country:US
Mailing Address - Phone:760-525-1111
Mailing Address - Fax:
Practice Address - Street 1:543 ENCINITAS BLVD STE 114
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3744
Practice Address - Country:US
Practice Address - Phone:760-525-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6359174400000X
CAOT6359225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist