Provider Demographics
NPI:1629412234
Name:JARVIS, AMBER MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:JARVIS
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 1:1537 HUTTON PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3505
Mailing Address - Country:US
Mailing Address - Phone:406-633-3863
Mailing Address - Fax:
Practice Address - Street 1:1537 HUTTON PL
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3505
Practice Address - Country:US
Practice Address - Phone:406-633-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1657224Z00000X
UT7367482-4202224Z00000X
NC8644224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant