Healthcare Provider Details

I. General information

NPI: 1407206808
Provider Name (Legal Business Name): ASHLEY BLAHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 LOCUST LN
HARRISBURG PA
17109-4444
US

IV. Provider business mailing address

4601 LOCUST LN
HARRISBURG PA
17109-4444
US

V. Phone/Fax

Practice location:
  • Phone: 717-526-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12521
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: