Provider Demographics
NPI:1912224676
Name:LILLY, AMBER MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:LILLY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SADDLE SHOP ROAD
Mailing Address - Street 2:
Mailing Address - City:HILLTOP
Mailing Address - State:WV
Mailing Address - Zip Code:25855-0125
Mailing Address - Country:US
Mailing Address - Phone:304-469-2966
Mailing Address - Fax:
Practice Address - Street 1:200 GREYSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-256-7579
Practice Address - Fax:304-256-0995
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1741225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist