Provider Demographics
NPI:1619149143
Name:TAGG, AMBER GRACE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:GRACE
Last Name:TAGG
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 1:33 OLD BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-2509
Mailing Address - Country:US
Mailing Address - Phone:207-615-3808
Mailing Address - Fax:
Practice Address - Street 1:10067 SOUTH AVE.
Practice Address - Street 2:10E #46
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365
Practice Address - Country:US
Practice Address - Phone:605-430-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10967225X00000X
AZ4003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist