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NPI Code Detail

MEDICARE: ASHLEY DAJAY ANTHONY

MEDICARE: ASHLEY DAJAY ANTHONY
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 Therapist056013256IL

General Provider Information

NPI Number : 1962047068
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY DAJAY ANTHONY
Provider Business Mailing Address
First Line : 18927 BARBARA CT
Second Line :
City : LANSING
State : IL
Zip : 60438-3601
Country : US
Telephone Number : 773-931-6119
Fax Number :
Provider Business Practice Location Address
First Line : 8200 185TH ST STE AB
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-9232
Country : US
Telephone Number : 708-580-0440
Fax Number : 708-263-0067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2019
Last Update Date : 11/12/2019

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Directions to “ ASHLEY DAJAY ANTHONY ” Practice Location

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