Provider Demographics
NPI:1578998423
Name:CONNELLY, ASHLEY MARIE (CTRS)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:MARIE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30845 EMBASSY ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5033
Mailing Address - Country:US
Mailing Address - Phone:248-642-2167
Mailing Address - Fax:
Practice Address - Street 1:35514 INDIGO DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4946
Practice Address - Country:US
Practice Address - Phone:586-212-2671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist