Provider Demographics
NPI:1649834250
Name:LOFRESE, ASHLEY NICOLE
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:LOFRESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SPROAT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2934
Mailing Address - Country:US
Mailing Address - Phone:845-800-3989
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3018
Practice Address - Country:US
Practice Address - Phone:845-454-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009164-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant