Provider Demographics
NPI:1326217613
Name:NOVAK, AMBER MICHELE (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17444 SLIPPER SHELL WAY UNIT 7
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6317
Mailing Address - Country:US
Mailing Address - Phone:302-503-2294
Mailing Address - Fax:302-644-2272
Practice Address - Street 1:1143 SAVANNAH RD STE 4
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1524
Practice Address - Country:US
Practice Address - Phone:302-503-2294
Practice Address - Fax:302-644-2272
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003075171100000X
WAMA00024009225700000X
DECQ-0000049171100000X
DEMT-0004161225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist