Provider Demographics
NPI:1750164588
Name:WEST, ASHLEE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14709 S 274TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-5524
Mailing Address - Country:US
Mailing Address - Phone:918-770-5940
Mailing Address - Fax:
Practice Address - Street 1:1207 S LEE ST
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-8757
Practice Address - Country:US
Practice Address - Phone:918-203-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3683225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant