Provider Demographics
NPI:1770292013
Name:ABRAHAM, ASHLEY (OTR/L, CLT-UE)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:OTR/L, CLT-UE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 WARWICK BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2344
Mailing Address - Country:US
Mailing Address - Phone:757-534-6127
Mailing Address - Fax:757-534-6151
Practice Address - Street 1:12200 WARWICK BLVD STE 170
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-6127
Practice Address - Fax:757-534-6151
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119007236OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONALS