=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831497262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY NICOLE QUILLEN OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2011
-----------------------------------------------------
Last Update Date | 04/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7350 DAIRY RD
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33540-1354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-788-4300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35740 TRUST LN
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33523-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 13562
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------