=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821247818
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER HUNSICKER II
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2008
-----------------------------------------------------
Last Update Date | 09/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 COMMUNITY DR
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43302-6487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-387-7537
-----------------------------------------------------
Fax | 740-383-2866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 COMMUNITY DR
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43302-6487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-387-7537
-----------------------------------------------------
Fax | 740-383-2866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 05951
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------