Provider Demographics
NPI:1164851879
Name:BECKER, AMBER LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNN
Last Name:BECKER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:GRISWOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:4782 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1049
Mailing Address - Country:US
Mailing Address - Phone:989-872-2174
Mailing Address - Fax:989-872-2204
Practice Address - Street 1:4782 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1049
Practice Address - Country:US
Practice Address - Phone:989-872-2174
Practice Address - Fax:989-872-2204
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007259224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant