Provider Demographics
NPI:1063807451
Name:ASH, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17204 123RD PL NE
Mailing Address - Street 2:APT N203
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9410
Mailing Address - Country:US
Mailing Address - Phone:206-787-0971
Mailing Address - Fax:
Practice Address - Street 1:17204 123RD PL NE
Practice Address - Street 2:APT N203
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9410
Practice Address - Country:US
Practice Address - Phone:206-787-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60390254225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist