Provider Demographics
NPI:1922781855
Name:NICOLE, ASHLYN
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:
Last Name:NICOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:NICOLE
Other - Last Name:HARKLEROAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9222 17TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2745
Mailing Address - Country:US
Mailing Address - Phone:509-294-8298
Mailing Address - Fax:
Practice Address - Street 1:34730 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6821
Practice Address - Country:US
Practice Address - Phone:253-927-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61176160225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant