Provider Demographics
NPI:1669253969
Name:STEWARTSON, ASHLEY (COTA/L)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:STEWARTSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 KESSLER MILL RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3047
Mailing Address - Country:US
Mailing Address - Phone:540-765-8504
Mailing Address - Fax:
Practice Address - Street 1:4550 SHENANDOAH AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-4749
Practice Address - Country:US
Practice Address - Phone:540-982-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001832224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant