Healthcare Provider Details

I. General information

NPI: 1003165473
Provider Name (Legal Business Name): ASHLEIGH DANIELLE SHINKLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEIGH DANIELLE RAMSEY OTR/L

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 IRELAND DR #A
FAYETTEVILLE NC
28304-4321
US

IV. Provider business mailing address

410 E PROSPECT AVE
RAEFORD NC
28376-2728
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-1605
  • Fax:
Mailing address:
  • Phone: 607-206-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: