Provider Demographics
NPI:1437570371
Name:MATHIASON, ASHLEY (OT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MATHIASON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:516 COOPER AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237
Mailing Address - Country:US
Mailing Address - Phone:701-352-2574
Mailing Address - Fax:701-352-0188
Practice Address - Street 1:516 COOPER AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237
Practice Address - Country:US
Practice Address - Phone:701-352-2574
Practice Address - Fax:701-352-0188
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56269Medicaid