Provider Demographics
NPI:1154468320
Name:ASHLEIGH KIDA
Entity Type:Organization
Organization Name:ASHLEIGH KIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:HONOR
Authorized Official - Last Name:KIDA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:9
Mailing Address - Street 1:75 WHEELER CIR
Mailing Address - Street 2:APT 116
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 WHEELER CIR
Practice Address - Street 2:APT 116
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1377
Practice Address - Country:US
Practice Address - Phone:9
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2650224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherCOTA
MA=========Medicaid
MA=========Medicaid
MA=========Medicare ID - Type UnspecifiedCOTA