Provider Demographics
NPI:1982380028
Name:POWELL, ASHTON SUE NICOLE
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:SUE NICOLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6456 AUTUMN VALLEY TRCE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:KY
Mailing Address - Zip Code:42376-9199
Mailing Address - Country:US
Mailing Address - Phone:270-315-6455
Mailing Address - Fax:
Practice Address - Street 1:815 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1252
Practice Address - Country:US
Practice Address - Phone:812-649-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246963224Z00000X
IN32003698A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant