Healthcare Provider Details

I. General information

NPI: 1942166970
Provider Name (Legal Business Name): ASHLEE NICOLE TIETO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27350 NICOLAS RD
TEMECULA CA
92591-7349
US

IV. Provider business mailing address

79 BRADSHAW DR
MANAHAWKIN NJ
08050-2361
US

V. Phone/Fax

Practice location:
  • Phone: 951-308-1988
  • Fax:
Mailing address:
  • Phone: 609-661-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: