Provider Demographics
NPI:1073949467
Name:ELLISON, ASHLEY MICHELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:ELLISON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:MICHELLE
Other - Last Name:FEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:207 W CONWAY ST.
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-778-4861
Mailing Address - Fax:501-776-5777
Practice Address - Street 1:207 W CONWAY ST.
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-778-4861
Practice Address - Fax:501-776-5777
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A776224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199525721Medicaid
AROT-A776OtherCOTA LIC #