Provider Demographics
NPI:1922446863
Name:MOSELEY, ASHLEY NICOLE (OTA)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 IVY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67117-8001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 IVY DR
Practice Address - Street 2:
Practice Address - City:NORTH NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67117-8001
Practice Address - Country:US
Practice Address - Phone:316-284-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03522224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant