Provider Demographics
NPI:1346585601
Name:ASHLEY, KATHLEEN (COTA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LAKEMANS LN
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2504
Mailing Address - Country:US
Mailing Address - Phone:978-500-5387
Mailing Address - Fax:
Practice Address - Street 1:63 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2240
Practice Address - Country:US
Practice Address - Phone:978-777-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3463224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3463OtherCOMMONWEALTH OF MASSACHUSETTS