Healthcare Provider Details

I. General information

NPI: 1730092743
Provider Name (Legal Business Name): ASHLEY NICOLE HODGES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 W EAU GALLIE BLVD STE 180
MELBOURNE FL
32934-7277
US

IV. Provider business mailing address

4450 W EAU GALLIE BLVD STE 180
MELBOURNE FL
32934-7277
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-6627
  • Fax: 321-253-9777
Mailing address:
  • Phone: 321-255-6627
  • Fax: 321-253-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: