Provider Demographics
NPI:1922211234
Name:FOSTY, AMBER MICHELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MICHELLE
Last Name:FOSTY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BEACON LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3801
Mailing Address - Country:US
Mailing Address - Phone:302-325-0678
Mailing Address - Fax:
Practice Address - Street 1:24 BEACON LN
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3801
Practice Address - Country:US
Practice Address - Phone:302-325-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0000754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist