Provider Demographics
NPI:1821558511
Name:WISE ROBBINS, AMBER (OTR/L)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WISE ROBBINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31626-3000
Mailing Address - Country:US
Mailing Address - Phone:229-263-9100
Mailing Address - Fax:
Practice Address - Street 1:260 MJ TAYLOR RD
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-3485
Practice Address - Country:US
Practice Address - Phone:229-896-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002524224Z00000X
GAOT009127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant