Provider Demographics
NPI:1912545245
Name:FERNANDEZ, AMBER (MOTR/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3138
Mailing Address - Country:US
Mailing Address - Phone:307-389-9867
Mailing Address - Fax:
Practice Address - Street 1:145 S DURBIN ST STE 105
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-7031
Practice Address - Country:US
Practice Address - Phone:307-389-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1420225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist