MEDICARE: ASHLEY B HARRELL O.T.

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	109860	TX
2	225XP0200X	Pediatric Occupational Therapist	109860	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T3849	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922131572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY B HARRELL O.T.

Provider Business Mailing Address
First Line	:	9101 TIMBER OAKS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3247
Country	:	US
Telephone Number	:	817-929-5655
Fax Number	:	817-335-1466

Provider Business Practice Location Address
First Line	:	9101 TIMBER OAKS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3247
Country	:	US
Telephone Number	:	817-929-5655
Fax Number	:	817-335-1466

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/06/2014

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