Provider Demographics
NPI:1548301575
Name:GORMAN, AMBER (OTR)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 BLANCO SPGS APT 1010
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4566
Mailing Address - Country:US
Mailing Address - Phone:210-452-2481
Mailing Address - Fax:
Practice Address - Street 1:8610 N NEW BRAUNFELS AVE
Practice Address - Street 2:#600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6370
Practice Address - Country:US
Practice Address - Phone:210-804-0193
Practice Address - Fax:210-804-0194
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109342225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics