Provider Demographics
NPI:1013361385
Name:DOUGLAS, AMBER (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NAPA VALLEY DR
Mailing Address - Street 2:APT 824
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5009
Mailing Address - Country:US
Mailing Address - Phone:501-952-5145
Mailing Address - Fax:
Practice Address - Street 1:629 JACK STEPHENS DR
Practice Address - Street 2:REHABILITATION SERVICES
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5525
Practice Address - Country:US
Practice Address - Phone:501-526-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist