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NPI Code Detail

MEDICARE: MS. ASHLEY NICOLE KWASNIUK OT

MEDICARE: MS. ASHLEY NICOLE KWASNIUK OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1063911006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ASHLEY NICOLE KWASNIUK OT
Provider Business Mailing Address
First Line : 77564 COUNTRY CLUB DR STE 340
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-0450
Country : US
Telephone Number : 760-772-2838
Fax Number :
Provider Business Practice Location Address
First Line : 77564 COUNTRY CLUB DR STE 340
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-0450
Country : US
Telephone Number : 760-772-2838
Fax Number : 760-772-2838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2018
Last Update Date : 03/17/2018

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