Provider Demographics
NPI:1114392404
Name:DOUGLASS, ASHLEY HELENE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:HELENE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-0152
Mailing Address - Country:US
Mailing Address - Phone:719-287-5589
Mailing Address - Fax:
Practice Address - Street 1:920 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4205
Practice Address - Country:US
Practice Address - Phone:360-428-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist