Provider Demographics
NPI:1114158862
Name:LIEPOLD, AMBER ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ANN
Last Name:LIEPOLD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:ANN
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80348 410TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56150-3181
Mailing Address - Country:US
Mailing Address - Phone:712-330-7943
Mailing Address - Fax:
Practice Address - Street 1:80348 410TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEFIELD
Practice Address - State:MN
Practice Address - Zip Code:56150-3181
Practice Address - Country:US
Practice Address - Phone:712-330-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103632225X00000X
IA01681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist