Provider Demographics
NPI:1326515149
Name:NIVENS, AMBER DAWN (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DAWN
Last Name:NIVENS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15879 W CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4668
Mailing Address - Country:US
Mailing Address - Phone:623-692-8074
Mailing Address - Fax:
Practice Address - Street 1:14239 W BELL RD STE 110
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2470
Practice Address - Country:US
Practice Address - Phone:623-544-1631
Practice Address - Fax:623-975-6144
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007531225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist