Provider Demographics
NPI:1831164532
Name:AMBORE, NANDA N (OTR,CLT-LANA)
Entity type:Individual
Prefix:MISS
First Name:NANDA
Middle Name:N
Last Name:AMBORE
Suffix:
Gender:F
Credentials:OTR,CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707
Mailing Address - Country:US
Mailing Address - Phone:432-689-2061
Mailing Address - Fax:432-689-2157
Practice Address - Street 1:1031 ANDREWS HWY #439
Practice Address - Street 2:MIDLAND WESTERN BUILDING
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-689-2061
Practice Address - Fax:432-689-2157
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170848901Medicaid
TX170848901Medicaid