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NPI Code Detail

MEDICARE: AMBER LEWIS OT

MEDICARE: AMBER LEWIS 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
1225X00000XOccupational TherapistOT004117GA

General Provider Information

NPI Number : 1750446068
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER LEWIS OT
Provider Business Mailing Address
First Line : 3044 DUE WEST RD
Second Line :
City : DALLAS
State : GA
Zip : 30157-2125
Country : US
Telephone Number : 770-443-9672
Fax Number : 770-505-3595
Provider Business Practice Location Address
First Line : 3044 DUE WEST RD
Second Line :
City : DALLAS
State : GA
Zip : 30157-2125
Country : US
Telephone Number : 770-443-9672
Fax Number : 770-505-3595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 07/08/2007

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