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General NPI Number Information
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NPI Number | 1497375067
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Entity Type | Individual
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Provider Name | ASHLEY DESROCHERS
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Gender | Female
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 158 ROSS RD
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City | KENNEBUNK
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State | ME
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Zip | 04043-6532
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Country | US
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Telephone | 207-604-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 345 SANFORD RD
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City | ALFRED
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State | ME
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Zip | 04002-3506
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Country | US
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Telephone |
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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 | OA2458
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License Number State | ME
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