Provider Demographics
NPI:1629706064
Name:ASHBY, KRISTY DAWN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:DAWN
Last Name:ASHBY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1830
Mailing Address - Country:US
Mailing Address - Phone:801-654-0264
Mailing Address - Fax:
Practice Address - Street 1:350 N STATE ST
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1830
Practice Address - Country:US
Practice Address - Phone:801-654-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11351661-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant