Provider Demographics
NPI:1073223707
Name:CARTER, ASHLEY RENAE (COTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENAE
Last Name:CARTER
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 1:247 CASINO DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-3816
Mailing Address - Country:US
Mailing Address - Phone:806-367-1308
Mailing Address - Fax:
Practice Address - Street 1:247 CASINO DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-3816
Practice Address - Country:US
Practice Address - Phone:806-367-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210902225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist