Provider Demographics
NPI:1982884938
Name:PATTERSON, AMBER NICOLE (OT R/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30639-0016
Mailing Address - Country:US
Mailing Address - Phone:706-491-3587
Mailing Address - Fax:
Practice Address - Street 1:277 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-2519
Practice Address - Country:US
Practice Address - Phone:706-491-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist