Provider Demographics
NPI:1063885960
Name:STIPE, ASHLEY NICOLE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:STIPE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:SEAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:342 COUNTY ROUTE 401
Mailing Address - Street 2:
Mailing Address - City:WESTERLO
Mailing Address - State:NY
Mailing Address - Zip Code:12193-3002
Mailing Address - Country:US
Mailing Address - Phone:518-810-5218
Mailing Address - Fax:
Practice Address - Street 1:1 RAPP RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4491
Practice Address - Country:US
Practice Address - Phone:518-867-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350542224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant