Provider Demographics
NPI:1982092755
Name:GOLDBERG, ASHLEY (OTR)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:301 N ALVARADO
Mailing Address - Street 2:APT #107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026
Mailing Address - Country:US
Mailing Address - Phone:561-281-3101
Mailing Address - Fax:
Practice Address - Street 1:8135 PAINTER AVE STE 201
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3166
Practice Address - Country:US
Practice Address - Phone:562-698-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14668225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics