Provider Demographics
NPI:1134916638
Name:PAVLAT, AMBER LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:PAVLAT
Suffix:
Gender:
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3663 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPALDING
Mailing Address - State:MI
Mailing Address - Zip Code:49886-9759
Mailing Address - Country:US
Mailing Address - Phone:906-236-4966
Mailing Address - Fax:
Practice Address - Street 1:2415 5TH AVE S
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1201
Practice Address - Country:US
Practice Address - Phone:906-786-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202008246224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant