Provider Demographics
NPI:1275057952
Name:BLACKSTOCK, ASHLEY SLEDGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SLEDGE
Last Name:BLACKSTOCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RENEE
Other - Last Name:SLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1, SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:5225 S LOOP 289 STE 210
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1319
Practice Address - Country:US
Practice Address - Phone:806-780-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117259225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist