=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740185966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER TUTTLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2026
-----------------------------------------------------
Last Update Date | 10/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2904 CARRIAGE MEADOWS DR
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-7052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-604-0429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2904 CARRIAGE MEADOWS DR
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-7052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-604-0429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 15208
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------