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General NPI Number Information
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NPI Number | 1114380144
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Entity Type | Individual
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Provider Name | ASHLEY M. C. DECO OT, CHT
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Gender | Female
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 4725 US HIGHWAY 98 S STE 101-102
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City | LAKELAND
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State | FL
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Zip | 33812-4334
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Country | US
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Telephone | 813-978-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 1888 15TH ST NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-1302
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Country | US
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Telephone | 863-956-6800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12243
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License Number State | NC
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