Healthcare Provider Details

I. General information

NPI: 1588917595
Provider Name (Legal Business Name): AMBER FAYE RUPERT MS, OTR/L, CKTP, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 MAPLEVILLE RD
BOONSBORO MD
21713-1818
US

IV. Provider business mailing address

23708 FOXVILLE RD
SMITHSBURG MD
21783-1913
US

V. Phone/Fax

Practice location:
  • Phone: 301-671-5040
  • Fax:
Mailing address:
  • Phone: 240-382-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number06914
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number06914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: