Provider Demographics
NPI:1124594908
Name:ROBERTSON, ASHLEY DONYE (COTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DONYE
Last Name:ROBERTSON
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 1:6010 CHAPARRALL CREEK CT APT 2922
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3965
Mailing Address - Country:US
Mailing Address - Phone:314-583-0207
Mailing Address - Fax:
Practice Address - Street 1:6010 CHAPARRALL CREEK CT APT 2922
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3965
Practice Address - Country:US
Practice Address - Phone:314-583-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215454224Z00000X
MO2020002066224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant