Provider Demographics
NPI:1104287085
Name:STEENEKAMP, ASHLEY JEAN (OTA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:JEAN
Last Name:STEENEKAMP
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 1:3901 71ST ST W LOT 23
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-6520
Mailing Address - Country:US
Mailing Address - Phone:941-451-9769
Mailing Address - Fax:
Practice Address - Street 1:3901 71ST ST W LOT 23
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-6520
Practice Address - Country:US
Practice Address - Phone:941-451-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13332172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker