Healthcare Provider Details

I. General information

NPI: 1922415843
Provider Name (Legal Business Name): ASHLEY THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 17TH ST
SARASOTA FL
34235-1843
US

IV. Provider business mailing address

2966 MORRIS DR
BARTOW FL
33830-9350
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-5400
  • Fax:
Mailing address:
  • Phone: 863-604-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: