Healthcare Provider Details

I. General information

NPI: 1790603769
Provider Name (Legal Business Name): AMBER ROSE O'BARR SANDERS LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER ROSE O'BARR

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 FRONT ST
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

4457 VERDUN AVE APT 5
FORT WAINWRIGHT AK
99703-1077
US

V. Phone/Fax

Practice location:
  • Phone: 703-258-6905
  • Fax:
Mailing address:
  • Phone: 714-494-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number228582
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: