Provider Demographics
NPI:1013310614
Name:MOATS, AMBER DAWN (MHA, ATC, LAT,)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:DAWN
Last Name:MOATS
Suffix:
Gender:F
Credentials:MHA, ATC, LAT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18501 MAUGANS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2990
Mailing Address - Country:US
Mailing Address - Phone:301-733-1700
Mailing Address - Fax:
Practice Address - Street 1:18501 MAUGANS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2990
Practice Address - Country:US
Practice Address - Phone:301-733-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00006082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer