Provider Demographics
NPI:1972913531
Name:BEBEAU, ASHLEY (COTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BEBEAU
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MELLEN
Mailing Address - State:WI
Mailing Address - Zip Code:54546-9750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 LAKE DR
Practice Address - Street 2:
Practice Address - City:MELLEN
Practice Address - State:WI
Practice Address - Zip Code:54546-9750
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIB1000138856906224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant