Provider Demographics
NPI:1104581958
Name:LY, ASHLEY AMBER (OTD, OTD/L)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AMBER
Last Name:LY
Suffix:
Gender:F
Credentials:OTD, OTD/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 NW QUIMBY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2666
Mailing Address - Country:US
Mailing Address - Phone:510-708-9048
Mailing Address - Fax:
Practice Address - Street 1:700 SW CAMPUS DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3107
Practice Address - Country:US
Practice Address - Phone:503-406-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics