Provider Demographics
NPI:1952157299
Name:NOVAK, ASHLIE
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:
Last Name:NOVAK
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 1:103 GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1306
Mailing Address - Country:US
Mailing Address - Phone:860-716-1807
Mailing Address - Fax:
Practice Address - Street 1:14 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-2307
Practice Address - Country:US
Practice Address - Phone:860-623-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist