Provider Demographics
NPI:1609528553
Name:MULLIS, AMBER LAMBERT (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LAMBERT
Last Name:MULLIS
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 1:5400 NC HWY 742
Mailing Address - Street 2:
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129
Mailing Address - Country:US
Mailing Address - Phone:704-425-6535
Mailing Address - Fax:
Practice Address - Street 1:5400 NC HWY 742
Practice Address - Street 2:
Practice Address - City:OAKBORO
Practice Address - State:NC
Practice Address - Zip Code:28129
Practice Address - Country:US
Practice Address - Phone:704-425-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4101224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4101OtherLICENSESURE
4101OtherLICENSEURE