Provider Demographics
NPI:1518277722
Name:BELL, AMBER ELIZABETH (COTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ELIZABETH
Last Name:BELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5605
Mailing Address - Country:US
Mailing Address - Phone:260-484-3120
Mailing Address - Fax:260-969-0104
Practice Address - Street 1:3420 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5605
Practice Address - Country:US
Practice Address - Phone:260-484-3120
Practice Address - Fax:260-969-0104
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001078A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant