Provider Demographics
NPI:1629780051
Name:BOUIC, ASHLEE NICOLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ASHLEE
Middle Name:NICOLE
Last Name:BOUIC
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2919
Mailing Address - Country:US
Mailing Address - Phone:614-269-4810
Mailing Address - Fax:
Practice Address - Street 1:136 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2698
Practice Address - Country:US
Practice Address - Phone:614-269-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT004746225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics