Provider Demographics
NPI:1689831653
Name:ROBINSON, AMBER MARIE WALLACE (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE WALLACE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4395 BLACKSMITH RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:NC
Mailing Address - Zip Code:28423-9075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1472 PICKNEY STREET
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472
Practice Address - Country:US
Practice Address - Phone:910-642-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5769224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant