Provider Demographics
NPI:1356668974
Name:FULKS, ASHLEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FULKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 7TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4083
Mailing Address - Country:US
Mailing Address - Phone:772-321-7663
Mailing Address - Fax:
Practice Address - Street 1:150 W 92ND ST APT BB
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7556
Practice Address - Country:US
Practice Address - Phone:212-595-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016070225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics