Provider Demographics
NPI:1063139343
Name:GABLE, ASHLEY MICHELLE (OTR)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:GABLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4720
Mailing Address - Country:US
Mailing Address - Phone:770-459-6533
Mailing Address - Fax:770-462-1260
Practice Address - Street 1:2001 CHURCH LN
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4720
Practice Address - Country:US
Practice Address - Phone:770-459-6533
Practice Address - Fax:770-462-1260
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008437225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist