Provider Demographics
NPI:1619601218
Name:MATURIN, ASHLEY (LMT LA#3935)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:MATURIN
Suffix:
Gender:F
Credentials:LMT LA#3935
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WINDERMERE CIR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5633
Mailing Address - Country:US
Mailing Address - Phone:337-254-0222
Mailing Address - Fax:
Practice Address - Street 1:142 WINDERMERE CIR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5633
Practice Address - Country:US
Practice Address - Phone:337-254-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3935OtherLOUISIANA MASSAGE LICENSE NUMBER