Provider Demographics
NPI:1265693469
Name:WOOTEN, ASHLEE BROOKE (OT)
Entity type:Individual
Prefix:MS
First Name:ASHLEE
Middle Name:BROOKE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1467
Mailing Address - Country:US
Mailing Address - Phone:304-342-9515
Mailing Address - Fax:
Practice Address - Street 1:113 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1467
Practice Address - Country:US
Practice Address - Phone:304-342-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1377225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012739Medicaid