Provider Demographics
NPI:1619214939
Name:CARLSON, ASHLEY RENE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RENE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3247
Mailing Address - Country:US
Mailing Address - Phone:814-362-1462
Mailing Address - Fax:814-362-1066
Practice Address - Street 1:20 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3247
Practice Address - Country:US
Practice Address - Phone:814-262-2621
Practice Address - Fax:814-262-1066
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017154660001OtherMA PROVIDER NUMBER