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General NPI Number Information
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NPI Number | 1750822581
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Entity Type | Individual
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Provider Name | AMBER RENEE FONTENOT ATC CSFA OPA-C OTC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1320 HIGHWAY 287 S
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City | MANSFIELD
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State | TX
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Zip | 76063-5701
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Country | US
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Telephone | 817-968-5806
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Fax | 915-703-7745
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Provider Business Mailing Address
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Address Line | 852 SUGARTREE DR
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City | CLEBURNE
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State | TX
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Zip | 76031-5253
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Country | US
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Telephone | 832-683-7666
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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