Provider Demographics
NPI:1710525621
Name:ASHLEY, DANIELLE TAYLOR (ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TAYLOR
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 HIGHWAY 4
Mailing Address - Street 2:
Mailing Address - City:DENNIS
Mailing Address - State:MS
Mailing Address - Zip Code:38838-9710
Mailing Address - Country:US
Mailing Address - Phone:662-316-1975
Mailing Address - Fax:
Practice Address - Street 1:15041 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1973
Practice Address - Country:US
Practice Address - Phone:256-331-0070
Practice Address - Fax:256-331-0054
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty