Provider Demographics
NPI:1568033512
Name:CHUCK, ASHLEY TADPOLES
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TADPOLES
Last Name:CHUCK
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 1:8101 BOAT CLUB RD STE 160
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3631
Mailing Address - Country:US
Mailing Address - Phone:214-302-9725
Mailing Address - Fax:
Practice Address - Street 1:1140 W PIONEER PKWY STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6383
Practice Address - Country:US
Practice Address - Phone:214-302-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist