Provider Demographics
NPI:1710204763
Name:KILCZEWSKI, AMBER R (OT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:R
Last Name:KILCZEWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:R
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 FIR ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3426
Mailing Address - Country:US
Mailing Address - Phone:360-259-3620
Mailing Address - Fax:360-515-0065
Practice Address - Street 1:1717 FIR ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3426
Practice Address - Country:US
Practice Address - Phone:360-259-3620
Practice Address - Fax:360-515-0065
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation