Provider Demographics
NPI:1013279538
Name:HOPKINS, AMBER DIANE (OT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DIANE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 S BROCKSMITH RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34945-4409
Mailing Address - Country:US
Mailing Address - Phone:772-460-1313
Mailing Address - Fax:772-460-1313
Practice Address - Street 1:2744 S BROCKSMITH RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34945-4409
Practice Address - Country:US
Practice Address - Phone:772-460-1313
Practice Address - Fax:772-460-1313
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT15262OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH