Provider Demographics
NPI:1891209672
Name:OGDEN, AMBER BROOKE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:BROOKE
Last Name:OGDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5778 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-5255
Mailing Address - Country:US
Mailing Address - Phone:706-300-1294
Mailing Address - Fax:
Practice Address - Street 1:7367 SPOUT SPRINGS RD STE 125
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5564
Practice Address - Country:US
Practice Address - Phone:770-965-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002295224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant