Provider Demographics
NPI:1598274334
Name:SHADLE, ASHLEY MICHELLE (OTR)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:SHADLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MICHELLE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3525 ENSIGN RD NE STE O-2
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-459-2771
Mailing Address - Fax:
Practice Address - Street 1:9881 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2805
Practice Address - Country:US
Practice Address - Phone:253-753-4008
Practice Address - Fax:253-276-0067
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60848907225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist