MEDICARE: AMBER EGERSON OTR/L, CLT

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	21447	FL

General Provider Information

NPI Number	:	1467845883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER EGERSON OTR/L, CLT

Provider Business Mailing Address
First Line	:	1620 TAMIAMI TRL STE 216
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-4017
Country	:	US
Telephone Number	:	941-888-4544
Fax Number	:	800-862-7560

Provider Business Practice Location Address
First Line	:	1620 TAMIAMI TRL STE 216
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-4017
Country	:	US
Telephone Number	:	941-888-4544
Fax Number	:	800-862-7560

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

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	05/23/2024

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