Provider Demographics
NPI:1093284044
Name:TRIPLETT, AMBER ROSE (DT-C)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:ROSE
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:DT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E SPRING ST APT 124
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2986
Mailing Address - Country:US
Mailing Address - Phone:502-475-2512
Mailing Address - Fax:
Practice Address - Street 1:2525 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2556
Practice Address - Country:US
Practice Address - Phone:812-945-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist