Provider Demographics
NPI:1841499514
Name:PAIGE, AMBER (PT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PAIGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:QUESNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:281 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2138
Mailing Address - Country:US
Mailing Address - Phone:508-334-1000
Mailing Address - Fax:508-856-3460
Practice Address - Street 1:281 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2138
Practice Address - Country:US
Practice Address - Phone:508-334-1000
Practice Address - Fax:508-856-3460
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015335225100000X
MA16393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4117OtherHAMP PROVIDER ID
113326OtherHEALTHLINK PROVIDER ID
IL203OtherBLUE CROSS PROVIDER ID
7216OtherPERSONALCARE PROVIDER ID
IL4117OtherHAMP PROVIDER ID