Provider Demographics
NPI:1093399701
Name:KOWALSKI, ASHTON (MSOT, OTRL)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:MSOT, OTRL
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:
Other - Last Name:TACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTRL
Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-840-8163
Mailing Address - Fax:
Practice Address - Street 1:235 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5247
Practice Address - Country:US
Practice Address - Phone:616-840-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist