Provider Demographics
NPI:1689022113
Name:ASHMORE, EBONY LAPORSCHE FEARS (OTR/L)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:LAPORSCHE FEARS
Last Name:ASHMORE
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 1:1227 PIN OAK DR
Mailing Address - Street 2:APT M4
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9702
Mailing Address - Country:US
Mailing Address - Phone:662-295-1932
Mailing Address - Fax:
Practice Address - Street 1:1227 PIN OAK DR
Practice Address - Street 2:APT M4
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9702
Practice Address - Country:US
Practice Address - Phone:662-295-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3089225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist