Provider Demographics
NPI:1497398283
Name:CONTRERAS, ASHLEY DAWN
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DAWN
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14342 SW AYNSLEY WAY
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1926
Mailing Address - Country:US
Mailing Address - Phone:503-886-9779
Mailing Address - Fax:
Practice Address - Street 1:10029 SW NIMBUS AVE STE 230
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7110
Practice Address - Country:US
Practice Address - Phone:503-568-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist