Provider Demographics
NPI:1902062870
Name:VANAMBURG, ROSS MARTIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:MARTIN
Last Name:VANAMBURG
Suffix:
Gender:M
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 1:3319 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4518
Mailing Address - Country:US
Mailing Address - Phone:308-631-5896
Mailing Address - Fax:
Practice Address - Street 1:4215 AVENUE I
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4902
Practice Address - Country:US
Practice Address - Phone:308-635-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist