Healthcare Provider Details

I. General information

NPI: 1558024679
Provider Name (Legal Business Name): ASHLEY ELLSWORTH OTD, OTR/L, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19300 SW 65TH AVE
TUALATIN OR
97062-7706
US

IV. Provider business mailing address

2125 VARIAN CIR
ARROYO GRANDE CA
93420-4900
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-1212
  • Fax:
Mailing address:
  • Phone:
  • 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: