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General NPI Number Information
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NPI Number | 1255076600
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Entity Type | Individual
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Provider Name | ASHLEIGH DIANE MCCULLOUGH
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Gender | Female
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Dates
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Enumeration Date | 04/30/2022
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Last Update Date | 04/30/2022
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Provider Practice Location Address
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Address Line | 650 S UNIVERSITY BLVD
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City | MOBILE
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State | AL
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Zip | 36609-7864
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Country | US
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Telephone | 251-220-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 123 PLUM BLUFF DR
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City | LUCEDALE
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State | MS
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Zip | 39452-3759
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Country | US
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Telephone | 334-379-0007
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1948
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License Number State | AL
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