Provider Demographics
NPI:1871835488
Name:KLUMPP, AMBER BROOKE (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:BROOKE
Last Name:KLUMPP
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 S PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7740
Mailing Address - Country:US
Mailing Address - Phone:602-819-4341
Mailing Address - Fax:
Practice Address - Street 1:3313 S PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7740
Practice Address - Country:US
Practice Address - Phone:602-819-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5418224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant