Individual
GREGORY AMBROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
150 N ROSENBERGER AVE, EVANSVILLE, IN 47712-6503
(812) 491-3856
Mailing address
10903 E GRANDVIEW DR, EVANSVILLE, IN 47712-9537
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
99041140A
IN
Other
Enumeration date
02/18/2010
Last updated
02/18/2010
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