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General NPI Number Information
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NPI Number | 1952966368
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Entity Type | Individual
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Provider Name | AMBER PAULINE COSTELLO OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 6347 ST PETERS CHURCH RD
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City | CONOVER
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State | NC
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Zip | 28613-8862
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Country | US
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Telephone | 704-608-6449
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Fax |
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Provider Business Mailing Address
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Address Line | 5251 PATTON RD
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City | MORGANTON
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State | NC
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Zip | 28655-7178
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Country | US
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Telephone | 217-827-6169
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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 | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number | 8154
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 8154
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 8154
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License Number State | NC
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