MEDICARE: ROBYN ASHLEN ENLOE 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
1	225X00000X	Occupational Therapist	OT61267673	WA
2	225X00000X	Occupational Therapist	7315-26	WI

General Provider Information

NPI Number	:	1598401028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN ASHLEN ENLOE OT

Provider Business Mailing Address
First Line	:	3001 COMMUNITY WAY APT 216
Second Line	:
City	:	MENASHA
State	:	WI
Zip	:	54952-5034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 N ROEMER RD
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-8628
Country	:	US
Telephone Number	:	920-997-1484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2022
Last Update Date	:	09/01/2024

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