Healthcare Provider Details

I. General information

NPI: 1932915899
Provider Name (Legal Business Name): ASHBALA OMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W TUSCALOOSA ST
FLORENCE AL
35630-5428
US

IV. Provider business mailing address

1541 HELTON DR APT I167
FLORENCE AL
35630-2493
US

V. Phone/Fax

Practice location:
  • Phone: 256-202-4885
  • Fax:
Mailing address:
  • Phone: 256-627-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-338381
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: