Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT004140 | GA |
NPI | 1003938515 |
---|---|
Provider Name | Mrs. Amber Marie Frick |
First Address | Chattanooga, TN 37411-4913 |
Second Address | Dalton, GA 30720-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |