Provider Demographics
NPI:1922131572
Name:HARRELL, ASHLEY B (OT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:B
Last Name:HARRELL
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 1:9101 TIMBER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3247
Mailing Address - Country:US
Mailing Address - Phone:817-929-5655
Mailing Address - Fax:817-335-1466
Practice Address - Street 1:9101 TIMBER OAKS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3247
Practice Address - Country:US
Practice Address - Phone:817-929-5655
Practice Address - Fax:817-335-1466
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109860225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3849OtherBLUE CROSS BLUE SHIELD
TX163724102Medicaid
TX005723401Medicaid