Healthcare Provider Details

I. General information

NPI: 1457837932
Provider Name (Legal Business Name): ASHLEY C THOMAS MSOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28991 OLD TOWN FRONT ST STE 101
TEMECULA CA
92590-2858
US

IV. Provider business mailing address

28991 OLD TOWN FRONT ST STE 101
TEMECULA CA
92590-2858
US

V. Phone/Fax

Practice location:
  • Phone: 951-556-8157
  • Fax:
Mailing address:
  • Phone: 951-556-8157
  • Fax: 951-414-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22265
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: