Provider Demographics
NPI:1295434074
Name:EISELE, ASHLEY (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:EISELE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11033 SCENIC BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6975
Mailing Address - Country:US
Mailing Address - Phone:214-604-2792
Mailing Address - Fax:
Practice Address - Street 1:11033 SCENIC BRUSH DR
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-6975
Practice Address - Country:US
Practice Address - Phone:214-604-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005425225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
397747OtherNBCOT CERTIFICATION
24368858OtherCDE PROFESSIONAL SPECIAL SERVICES LICENSE
COOT.0005425OtherSTATE LICENCE