MEDICARE: ASHLEY EFAW 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	225XP0200X	Pediatric Occupational Therapist	1612	OK

General Provider Information

NPI Number	:	1598165086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY EFAW OTR/L

Provider Business Mailing Address
First Line	:	1615 S EUCALYPTUS AVE
Second Line	:	SUITE 208
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 S EUCALYPTUS AVE
Second Line	:	SUITE 208
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6159
Country	:	US
Telephone Number	:	918-630-7334
Fax Number	:

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

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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Directions to “ ASHLEY EFAW OTR/L” Practice Location

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