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General NPI Number Information
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NPI Number | 1881341279
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Entity Type | Individual
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Provider Name | AMBER ALEXSANDRA TICKLE
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Gender | Female
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 500 SPRINGFIELD ROAD
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City | SYRACUSE
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State | NY
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Zip | 13214
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Country | US
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Telephone | 315-445-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 3 OBRIEN GLENWAY
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City | OSWEGO
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State | NY
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Zip | 13126-9251
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Country | US
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Telephone | 315-529-6448
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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 | NY
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