Provider Demographics
NPI:1114334596
Name:WELSH, AMBER (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WELSH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 TAYLOR OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:28112
Mailing Address - Country:US
Mailing Address - Phone:704-261-4197
Mailing Address - Fax:
Practice Address - Street 1:1000 TANDAL PL
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8842
Practice Address - Country:US
Practice Address - Phone:919-266-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9273224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant