Healthcare Provider Details

I. General information

NPI: 1578215372
Provider Name (Legal Business Name): AMY LYNN AMBERGER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 BEECH RD
ELIOT ME
03903-1919
US

IV. Provider business mailing address

88 BEECH RD
ELIOT ME
03903-1919
US

V. Phone/Fax

Practice location:
  • Phone: 207-703-8897
  • Fax:
Mailing address:
  • Phone: 207-703-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT1344
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOT1344
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: