Provider Demographics
NPI:1194591743
Name:MOYER, AMBER
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2928
Mailing Address - Country:US
Mailing Address - Phone:937-580-8572
Mailing Address - Fax:
Practice Address - Street 1:41 POPLAR ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2928
Practice Address - Country:US
Practice Address - Phone:937-580-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant