Healthcare Provider Details

I. General information

NPI: 1669829073
Provider Name (Legal Business Name): ASHLEE WARD M.S OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEE GIBBONS M.S OTR/L

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 OLD NEWPORT ST
NANTICOKE PA
18634-1327
US

IV. Provider business mailing address

319 MEADOWCREST DR
SHAVERTOWN PA
18708-9482
US

V. Phone/Fax

Practice location:
  • Phone: 570-735-7300
  • Fax:
Mailing address:
  • Phone: 570-709-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOC013934
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOC013934
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: