Healthcare Provider Details

I. General information

NPI: 1922584556
Provider Name (Legal Business Name): AMBER ELLEN SHANK MSOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 INDUSTRY LN STE 5A
FOREST HILL MD
21050-1741
US

IV. Provider business mailing address

138 INDUSTRY LN STE 5A
FOREST HILL MD
21050-1741
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-3768
  • Fax:
Mailing address:
  • Phone: 410-578-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number07950
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: