Provider Demographics
NPI:1124770060
Name:KNUCKLES, AMBER ALAYNE
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ALAYNE
Last Name:KNUCKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BRADLEY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71647-9304
Mailing Address - Country:US
Mailing Address - Phone:870-820-2349
Mailing Address - Fax:
Practice Address - Street 1:408 CHERRY ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2113
Practice Address - Country:US
Practice Address - Phone:870-226-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1763224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant