Provider Demographics
NPI:1609320399
Name:DAUGHERTY, ASHLEI (NEUROMODULATION TECH)
Entity Type:Individual
Prefix:
First Name:ASHLEI
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:NEUROMODULATION TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 N LAMAR BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-1337
Mailing Address - Country:US
Mailing Address - Phone:512-977-7000
Mailing Address - Fax:512-977-7001
Practice Address - Street 1:12345 N LAMAR BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1337
Practice Address - Country:US
Practice Address - Phone:512-977-7000
Practice Address - Fax:512-977-7001
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical