Provider Demographics
NPI:1710535075
Name:HARKRIDER, ASHLEY (COTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HARKRIDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:SOAPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5650
Mailing Address - Country:US
Mailing Address - Phone:903-234-0000
Mailing Address - Fax:
Practice Address - Street 1:2201 HORSESHOE LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5650
Practice Address - Country:US
Practice Address - Phone:903-234-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209293224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant