MEDICARE: MRS. ASHLEY HAITH SALAZAR BA

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	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1811048358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY HAITH SALAZAR BA

Provider Business Mailing Address
First Line	:	2488 PATTON LN
Second Line	:
City	:	FRANKLINTON
State	:	NC
Zip	:	27525-9472
Country	:	US
Telephone Number	:	252-767-1059
Fax Number	:	919-692-1119

Provider Business Practice Location Address
First Line	:	2488 PATTON LN
Second Line	:
City	:	FRANKLINTON
State	:	NC
Zip	:	27525-9472
Country	:	US
Telephone Number	:	252-767-1059
Fax Number	:	919-692-1119

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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