Provider Demographics
NPI:1962825901
Name:BERNARD, AMBER SHAREE (COTAL)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:SHAREE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44738 MORLEY DRIVE
Mailing Address - Street 2:CENTER FOR TLC
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-421-4062
Mailing Address - Fax:586-421-4072
Practice Address - Street 1:44738 MORLEY DRIVE
Practice Address - Street 2:CENTER FOR TLC
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-421-4062
Practice Address - Fax:586-421-4072
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007751224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant