Provider Demographics
NPI:1376633404
Name:AMBER MUSTARD
Entity Type:Organization
Organization Name:AMBER MUSTARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTARD
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF OTR/L
Authorized Official - Phone:615-361-6140
Mailing Address - Street 1:1609 MURFREESBORO PIKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2924
Mailing Address - Country:US
Mailing Address - Phone:615-361-6140
Mailing Address - Fax:615-361-6141
Practice Address - Street 1:1609 MURFREESBORO PIKE
Practice Address - Street 2:SUITE E
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2924
Practice Address - Country:US
Practice Address - Phone:615-361-6140
Practice Address - Fax:615-361-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000002963225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty