Provider Demographics
NPI:1356893390
Name:MARTIN, AMBER JOY (OTR/L)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JOY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JOY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2701
Mailing Address - Country:US
Mailing Address - Phone:540-908-6225
Mailing Address - Fax:
Practice Address - Street 1:100 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2701
Practice Address - Country:US
Practice Address - Phone:540-908-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist