Healthcare Provider Details

I. General information

NPI: 1659539849
Provider Name (Legal Business Name): AMBER-RAE MAE SPENCER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2008
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 MAIN ST
CLIFTON FORGE VA
24422-1905
US

IV. Provider business mailing address

3701 POTTS CREEK RD
COVINGTON VA
24426-6822
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-5791
  • Fax:
Mailing address:
  • Phone: 585-322-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119005523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: