Provider Demographics
NPI:1639632300
Name:LATHRAM, ASHLEIGH (OTR/L)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:LATHRAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:
Other - Last Name:BAGSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7710 FERRY LAUNCH WAY APT 5301
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8685
Mailing Address - Country:US
Mailing Address - Phone:937-403-7668
Mailing Address - Fax:919-263-9605
Practice Address - Street 1:620 DR CALVIN JONES HWY
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3100
Practice Address - Country:US
Practice Address - Phone:919-673-4246
Practice Address - Fax:919-263-9605
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty