Healthcare Provider Details

I. General information

NPI: 1790238210
Provider Name (Legal Business Name): ASHLEE LEWIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 SHASTA LILY DR
ELK GROVE CA
95624-3883
US

IV. Provider business mailing address

2775 LAND PARK DR
SACRAMENTO CA
95818-2938
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-8820
  • Fax:
Mailing address:
  • Phone: 916-307-9757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: