Provider Demographics
NPI:1700350816
Name:CRAWFORD, AMBER RICHELE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RICHELE
Last Name:CRAWFORD
Suffix:
Gender:F
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 1:1336 S EDGEWATER CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6283
Mailing Address - Country:US
Mailing Address - Phone:740-424-3140
Mailing Address - Fax:
Practice Address - Street 1:4696 W OVERLAND RD STE 232
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2864
Practice Address - Country:US
Practice Address - Phone:208-908-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1968224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant