Healthcare Provider Details

I. General information

NPI: 1831718964
Provider Name (Legal Business Name): ASHLEY ANN OHERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W AGENCY RD
WEST BURLINGTON IA
52655-1659
US

IV. Provider business mailing address

1221 S GEAR AVE
WEST BURLINGTON IA
52655-1679
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004815
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number004815
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: