Provider Demographics
NPI:1255110656
Name:COPELAND, AMBER KRISTINA (OT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:KRISTINA
Last Name:COPELAND
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 1:3964 ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1231
Mailing Address - Country:US
Mailing Address - Phone:863-214-9962
Mailing Address - Fax:
Practice Address - Street 1:200 NASSAU ST N
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-1772
Practice Address - Country:US
Practice Address - Phone:941-485-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15451208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty