Provider Demographics
NPI:1396910477
Name:WOLFE, ASHLEY ALISON (OTR)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ALISON
Last Name:WOLFE
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 1:320 ELM ST.
Mailing Address - Street 2:P.O. BOX 45
Mailing Address - City:GRANTON
Mailing Address - State:WI
Mailing Address - Zip Code:54436
Mailing Address - Country:US
Mailing Address - Phone:715-238-8092
Mailing Address - Fax:
Practice Address - Street 1:320 ELM ST.
Practice Address - Street 2:
Practice Address - City:GRANTON
Practice Address - State:WI
Practice Address - Zip Code:54436
Practice Address - Country:US
Practice Address - Phone:715-238-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4397-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40902300Medicaid