Provider Demographics
NPI:1821575135
Name:WILLIS, AMBER ELIZABETH (ATC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ELIZABETH
Last Name:WILLIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ELIZABETH
Other - Last Name:BONHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2201 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-6233
Mailing Address - Country:US
Mailing Address - Phone:918-899-0567
Mailing Address - Fax:
Practice Address - Street 1:2201 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-6233
Practice Address - Country:US
Practice Address - Phone:918-335-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer