Provider Demographics
NPI:1144533605
Name:DICKEN, AMBERLEE (COTA)
Entity type:Individual
Prefix:
First Name:AMBERLEE
Middle Name:
Last Name:DICKEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 EDEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-3164
Mailing Address - Country:US
Mailing Address - Phone:804-363-7496
Mailing Address - Fax:
Practice Address - Street 1:536 EDEN FARM RD
Practice Address - Street 2:
Practice Address - City:BUMPASS
Practice Address - State:VA
Practice Address - Zip Code:23024-3164
Practice Address - Country:US
Practice Address - Phone:804-363-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000692224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant