Provider Demographics
NPI:1265828602
Name:OTIS, ASHELY TIERNEY (APSW)
Entity Type:Individual
Prefix:
First Name:ASHELY
Middle Name:TIERNEY
Last Name:OTIS
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KESSEL CT
Mailing Address - Street 2:STE 105
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:608-280-2700
Mailing Address - Fax:608-280-2707
Practice Address - Street 1:1320 MENDOTA ST
Practice Address - Street 2:STE 120
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1096
Practice Address - Country:US
Practice Address - Phone:608-280-3180
Practice Address - Fax:608-280-3185
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker