Provider Demographics
NPI:1184909756
Name:CASEY, AMBER L (COTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:CASEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9447
Mailing Address - Country:US
Mailing Address - Phone:509-783-5282
Mailing Address - Fax:509-783-5282
Practice Address - Street 1:7820 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9447
Practice Address - Country:US
Practice Address - Phone:509-783-5282
Practice Address - Fax:509-783-5282
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60240272224Z00000X
OR287481224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant