Provider Demographics
NPI:1134853252
Name:WILMUTH, ASHTEN NICOLE (OTR)
Entity type:Individual
Prefix:
First Name:ASHTEN
Middle Name:NICOLE
Last Name:WILMUTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29704 JADE ST
Mailing Address - Street 2:
Mailing Address - City:CASHION
Mailing Address - State:OK
Mailing Address - Zip Code:73016-9304
Mailing Address - Country:US
Mailing Address - Phone:580-745-4045
Mailing Address - Fax:
Practice Address - Street 1:9401 N KELLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-2442
Practice Address - Country:US
Practice Address - Phone:405-397-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist