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General NPI Number Information
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NPI Number | 1295019933
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Entity Type | Individual
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Provider Name | AMBER D CUNNINGTON LMP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 135 OGILVIE LN
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City | OLDTOWN
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State | ID
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Zip | 83822-7517
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Country | US
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Telephone | 509-589-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 135 OGILVIE LN
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City | OLDTOWN
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State | ID
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Zip | 83822-7517
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Country | US
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Telephone | 509-589-0213
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60243351
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License Number State | WA
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