Provider Demographics
NPI:1093150872
Name:BARTLETT, ASHLEY RYAN (COTA/L)
Entity type:Individual
Prefix:MR
First Name:ASHLEY
Middle Name:RYAN
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24794 W JONES AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3356
Mailing Address - Country:US
Mailing Address - Phone:623-693-1792
Mailing Address - Fax:
Practice Address - Street 1:500 N BULLARD AVE
Practice Address - Street 2:SUITE #27
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2533
Practice Address - Country:US
Practice Address - Phone:623-986-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#5352224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant