Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 8154 | NC |
N | 225XM0800X | Mental Health | 8154 | NC |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 8154 |
NPI | 1952966368 |
---|---|
Provider Name | Dr. Amber Pauline Costello |
First Address | Morganton, NC 28655-7178 |
Second Address | Conover, NC 28613-8862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 01/05/2019 |