Healthcare Provider Details

I. General information

NPI: 1467027235
Provider Name (Legal Business Name): ASHLEIGH ELIZABETH WASYLK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 HILLEGAS RD STE 200
FORT WAYNE IN
46818
US

IV. Provider business mailing address

4835 HILLEGAS RD STE 200
FORT WAYNE IN
46818
US

V. Phone/Fax

Practice location:
  • Phone: 260-338-1241
  • Fax:
Mailing address:
  • Phone: 260-338-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: