Provider Demographics
NPI:1457651218
Name:ANDERSON, AMBER R (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 CUMBERLAND PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1808
Mailing Address - Country:US
Mailing Address - Phone:770-436-5125
Mailing Address - Fax:770-432-5908
Practice Address - Street 1:2401 CUMBERLAND PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-1808
Practice Address - Country:US
Practice Address - Phone:770-436-5125
Practice Address - Fax:770-432-5908
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist