Provider Demographics
NPI:1346480829
Name:POWERS, AMBER NICHOLE (CMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:POWERS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-0277
Mailing Address - Country:US
Mailing Address - Phone:480-612-3255
Mailing Address - Fax:406-682-3451
Practice Address - Street 1:2415 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3809
Practice Address - Country:US
Practice Address - Phone:406-595-1928
Practice Address - Fax:406-551-2085
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist