Provider Demographics
NPI:1598310963
Name:FRYER, AMBER LE (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LE
Last Name:FRYER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 BROAD ST APT A
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-2213
Mailing Address - Country:US
Mailing Address - Phone:570-506-0720
Mailing Address - Fax:
Practice Address - Street 1:15 RIDGECREST CIR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6367
Practice Address - Country:US
Practice Address - Phone:570-506-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009566224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant