Provider Demographics
NPI:1497425235
Name:MARTIN, ASHLEY GULLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GULLY
Last Name:MARTIN
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 1:31 CATALINA CT
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1569
Mailing Address - Country:US
Mailing Address - Phone:832-512-9416
Mailing Address - Fax:
Practice Address - Street 1:17200 STATE HIGHWAY 249 STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1319
Practice Address - Country:US
Practice Address - Phone:281-664-6900
Practice Address - Fax:281-374-1788
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist