Provider Demographics
NPI:1154947828
Name:CARROLL, ASHLYN NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:NICOLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 S BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2675
Mailing Address - Country:US
Mailing Address - Phone:580-278-9707
Mailing Address - Fax:
Practice Address - Street 1:612 W 18TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3631
Practice Address - Country:US
Practice Address - Phone:405-330-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist