Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 116790 | TX |
N | 225X00000X | Occupational Therapist | OT-1803 | ID |
NPI | 1003320441 |
---|---|
Provider Name | Joy Ashley |
First Address | Manchester, NH 03103-6109 |
Second Address | Manchester, NH 03103-6109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2017 |
Last Update Date | 21/11/2017 |