Provider Demographics
NPI:1275159741
Name:FOWLER, ASHLEY JUSTINE (RBT-20-119226)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JUSTINE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RBT-20-119226
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:JUSTINE
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASHLEY FOWLER
Mailing Address - Street 1:14340 SW 260TH ST UNIT 501
Mailing Address - Street 2:
Mailing Address - City:NARANJA
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6629
Mailing Address - Country:US
Mailing Address - Phone:305-879-8310
Mailing Address - Fax:
Practice Address - Street 1:14340 SW 260TH ST UNIT 501
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-6629
Practice Address - Country:US
Practice Address - Phone:305-879-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-119226106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician