Provider Demographics
NPI:1376945246
Name:THOMAS, ASHLYN BLYTHE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:BLYTHE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:THOMAS
Other - Last Name:DELOACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3322 GREYSTONE WAY
Mailing Address - Street 2:STE B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7422
Mailing Address - Country:US
Mailing Address - Phone:229-469-6932
Mailing Address - Fax:229-469-6933
Practice Address - Street 1:3322 GREYSTONE WAY
Practice Address - Street 2:SUITE B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7421
Practice Address - Country:US
Practice Address - Phone:229-469-6932
Practice Address - Fax:229-469-6933
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist