Healthcare Provider Details

I. General information

NPI: 1487248183
Provider Name (Legal Business Name): ASHLEY D FOURNIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 WILBRAHAM RD
SPRINGFIELD MA
01109-2067
US

IV. Provider business mailing address

31 BETTY RD
ENFIELD CT
06082-2623
US

V. Phone/Fax

Practice location:
  • Phone: 413-782-1800
  • Fax:
Mailing address:
  • Phone: 860-712-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001176
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: