MEDICARE: MISS ASHLYN MARIE DENAULT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT12393	OH

General Provider Information

NPI Number	:	1427880012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ASHLYN MARIE DENAULT OTR/L

Provider Business Mailing Address
First Line	:	5280 BEECHMONT AVE UNIT 2136
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2509
Country	:	US
Telephone Number	:	815-954-5495
Fax Number	:

Provider Business Practice Location Address
First Line	:	5280 BEECHMONT AVE UNIT 2136
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2509
Country	:	US
Telephone Number	:	815-954-5495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	10/28/2024

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