Provider Demographics
NPI:1619444775
Name:HALTERMAN, ASHLEIGH LOUISE
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:LOUISE
Last Name:HALTERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24176 DANCING STREAM SPUR RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-7381
Mailing Address - Country:US
Mailing Address - Phone:405-517-4863
Mailing Address - Fax:
Practice Address - Street 1:118 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-3208
Practice Address - Country:US
Practice Address - Phone:405-379-5256
Practice Address - Fax:405-379-5381
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator