Provider Demographics
NPI:1518031251
Name:MOORE, ASHLEY ELLIOTT (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ELLIOTT
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CORNELIA CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-4217
Mailing Address - Country:US
Mailing Address - Phone:615-788-0492
Mailing Address - Fax:615-628-8107
Practice Address - Street 1:612 CORNELIA CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-4217
Practice Address - Country:US
Practice Address - Phone:615-788-0492
Practice Address - Fax:615-628-8107
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111292225X00000X
TN4595225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530816Medicaid
TX0045JNOtherBLUE CROSS BLUE SHEILD ID
TX050551331OtherTAX ID FOR CLINIC