Provider Demographics
NPI:1811355407
Name:VANHATTEN, ASHLEY (OTRL)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:VANHATTEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MARSH PUNGO RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23092-9802
Mailing Address - Country:US
Mailing Address - Phone:804-758-5260
Mailing Address - Fax:
Practice Address - Street 1:74 MARSH PUNGO ROAD
Practice Address - Street 2:
Practice Address - City:LOCUST HILL
Practice Address - State:VA
Practice Address - Zip Code:23092
Practice Address - Country:US
Practice Address - Phone:804-758-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006717225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist