Provider Demographics
NPI:1114380144
Name:DECO, ASHLEY M C (OT, CHT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M C
Last Name:DECO
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:COUDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1888 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1302
Mailing Address - Country:US
Mailing Address - Phone:863-956-6800
Mailing Address - Fax:
Practice Address - Street 1:4725 US HIGHWAY 98 S STE 101-102
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4334
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty