Provider Demographics
NPI:1104280874
Name:POSPISIL, AMBER (COTA/L, CLT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:POSPISIL
Suffix:
Gender:F
Credentials:COTA/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 ASHLEY LN APT 235
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-1235
Mailing Address - Country:US
Mailing Address - Phone:320-491-5937
Mailing Address - Fax:
Practice Address - Street 1:4890 ASHLEY LN
Practice Address - Street 2:APT 235
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1265
Practice Address - Country:US
Practice Address - Phone:320-491-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5227-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant