Healthcare Provider Details

I. General information

NPI: 1942693577
Provider Name (Legal Business Name): ASHLEY HOTZ LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 LACEY BLVD SE
LACEY WA
98503-5733
US

IV. Provider business mailing address

5520 MOUNTAIN GREENS LANE SE
LACEY WA
98503-5733
US

V. Phone/Fax

Practice location:
  • Phone: 360-561-0171
  • Fax:
Mailing address:
  • Phone: 907-799-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60498187
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: