Provider Demographics
NPI:1467845883
Name:EGERSON, AMBER (OTR/L, CLT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:EGERSON
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 TAMIAMI TRL STE 216
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-4017
Mailing Address - Country:US
Mailing Address - Phone:941-888-4544
Mailing Address - Fax:800-862-7560
Practice Address - Street 1:1620 TAMIAMI TRL STE 216
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-4017
Practice Address - Country:US
Practice Address - Phone:941-888-4544
Practice Address - Fax:800-862-7560
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist