Provider Demographics
NPI:1356562326
Name:DODSON, AMBER RENAE (MED, ATC)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:RENAE
Last Name:DODSON
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2388
Mailing Address - Country:US
Mailing Address - Phone:573-592-4398
Mailing Address - Fax:573-592-4386
Practice Address - Street 1:1 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2388
Practice Address - Country:US
Practice Address - Phone:573-592-4398
Practice Address - Fax:573-592-4386
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040223062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer