Provider Demographics
NPI:1740569029
Name:EDMONDS, ASHLEY (OT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HARCOURT RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3946
Mailing Address - Country:US
Mailing Address - Phone:740-392-8811
Mailing Address - Fax:740-392-6485
Practice Address - Street 1:351 S LANE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2319
Practice Address - Country:US
Practice Address - Phone:419-562-6686
Practice Address - Fax:419-562-6625
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 007700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist