Provider Demographics
NPI:1568637510
Name:ANNEN, ASHLEY LEIGH ALISON (OTR/L CLT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LEIGH ALISON
Last Name:ANNEN
Suffix:
Gender:F
Credentials:OTR/L CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13136 SPARROW CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8701
Mailing Address - Country:US
Mailing Address - Phone:708-301-8096
Mailing Address - Fax:
Practice Address - Street 1:3707 WEST LAKE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-997-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007925225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist