Provider Demographics
NPI:1750822581
Name:FONTENOT, AMBER RENEE (ATC CSFA OPA-C OTC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RENEE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:ATC CSFA OPA-C OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 SUGARTREE DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-5253
Mailing Address - Country:US
Mailing Address - Phone:832-683-7666
Mailing Address - Fax:
Practice Address - Street 1:1320 HIGHWAY 287 S
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5701
Practice Address - Country:US
Practice Address - Phone:817-968-5806
Practice Address - Fax:915-703-7745
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT9356OtherLAT
100280128OtherNBSTSA
20-9011OtherNBCOTA