Healthcare Provider Details

I. General information

NPI: 1922476662
Provider Name (Legal Business Name): ASHLEY MARDINLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 DOGWOOD LN
BROOMALL PA
19008-1018
US

IV. Provider business mailing address

2929 DOGWOOD LN
BROOMALL PA
19008-1018
US

V. Phone/Fax

Practice location:
  • Phone: 215-896-9013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC020990
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5247
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: