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General NPI Number Information
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NPI Number | 1659500965
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Entity Type | Individual
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Provider Name | AMBER PRINCE PTA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 2334 SE WASHINGTON BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006-7256
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Country | US
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Telephone | 918-331-9184
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Fax | 918-331-9187
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Provider Business Mailing Address
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Address Line | 10100 FOREST HILLS RD
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City | MACHESNEY PARK
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State | IL
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Zip | 61115-8234
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Country | US
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Telephone | 815-713-2738
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Fax | 815-713-2797
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1269
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License Number State | OK
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