Provider Demographics
NPI:1295019933
Name:CUNNINGTON, AMBER D (LMP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:D
Last Name:CUNNINGTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OGILVIE LN
Mailing Address - Street 2:
Mailing Address - City:OLDTOWN
Mailing Address - State:ID
Mailing Address - Zip Code:83822-7517
Mailing Address - Country:US
Mailing Address - Phone:509-589-0213
Mailing Address - Fax:
Practice Address - Street 1:135 OGILVIE LN
Practice Address - Street 2:
Practice Address - City:OLDTOWN
Practice Address - State:ID
Practice Address - Zip Code:83822-7517
Practice Address - Country:US
Practice Address - Phone:509-589-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60243351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist