Provider Demographics
NPI:1932387529
Name:SHUTT, AMBER M (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:SHUTT
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-9413
Mailing Address - Country:US
Mailing Address - Phone:570-204-4066
Mailing Address - Fax:
Practice Address - Street 1:2140 WARRENSVILLE RD
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9621
Practice Address - Country:US
Practice Address - Phone:570-433-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist