Provider Demographics
NPI:1659539849
Name:SPENCER, AMBER-RAE MAE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:AMBER-RAE
Middle Name:MAE
Last Name:SPENCER
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 1:3701 POTTS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-6822
Mailing Address - Country:US
Mailing Address - Phone:585-322-3912
Mailing Address - Fax:
Practice Address - Street 1:1725 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422-1905
Practice Address - Country:US
Practice Address - Phone:540-862-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-25
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist