Provider Demographics
NPI:1275865578
Name:CASSIDY, ASHLEY R (ATC, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:R
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:ATC, OTR/L
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:R
Other - Last Name:HOLST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, OTR/L
Mailing Address - Street 1:1300 FAYETTE ST
Mailing Address - Street 2:APT. 93
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1337
Mailing Address - Country:US
Mailing Address - Phone:484-532-7111
Mailing Address - Fax:
Practice Address - Street 1:1300 FAYETTE ST
Practice Address - Street 2:APT. 93
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1337
Practice Address - Country:US
Practice Address - Phone:484-532-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0040442255A2300X
PARTO0000192255A2300X
PAOC012155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22OtherNATA