Provider Demographics
NPI:1811382211
Name:CARTER, AMBER DAWN (COTA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:CARTER
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 1:100784 S 3540 RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:OK
Mailing Address - Zip Code:74869-1002
Mailing Address - Country:US
Mailing Address - Phone:918-694-7301
Mailing Address - Fax:
Practice Address - Street 1:5800 E SKELLY DR STE 402
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6441
Practice Address - Country:US
Practice Address - Phone:918-497-1068
Practice Address - Fax:918-497-1069
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1294224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant