MEDICARE: AMBER DIANE HOPKINS OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT15262	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT15262	OTHER	FL	STATE OF FLORIDA DEPARTMENT OF HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013279538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER DIANE HOPKINS OT

Provider Business Mailing Address
First Line	:	2744 S BROCKSMITH RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-4409
Country	:	US
Telephone Number	:	772-460-1313
Fax Number	:	772-460-1313

Provider Business Practice Location Address
First Line	:	2744 S BROCKSMITH RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-4409
Country	:	US
Telephone Number	:	772-460-1313
Fax Number	:	772-460-1313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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