Provider Demographics
NPI:1275127672
Name:HART, ASHLEY (RBT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1824 TOUBY PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-2573
Mailing Address - Country:US
Mailing Address - Phone:765-628-7400
Mailing Address - Fax:855-940-0177
Practice Address - Street 1:745 ORIENTA AVE STE 1011
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32701-5675
Practice Address - Country:US
Practice Address - Phone:877-823-4283
Practice Address - Fax:352-332-8589
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician