Healthcare Provider Details

I. General information

NPI: 1508358136
Provider Name (Legal Business Name): ASHLEY DREW SPIVEY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 CHIPPENDALE RD
ROCHESTER NY
14616-3936
US

IV. Provider business mailing address

84 CHIPPENDALE RD
ROCHESTER NY
14616-3936
US

V. Phone/Fax

Practice location:
  • Phone: 585-322-2360
  • Fax:
Mailing address:
  • Phone: 585-322-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number009750
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: