Healthcare Provider Details

I. General information

NPI: 1750809950
Provider Name (Legal Business Name): ASHLEY COLBURN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 LAGUNA DR
CARLSBAD CA
92008-1607
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-730-9675
  • Fax:
Mailing address:
  • Phone: 760-633-6057
  • Fax: 760-633-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: