Provider Demographics
NPI:1154990901
Name:FRYMIRE, ASHLEY NICHOLE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:FRYMIRE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:N
Other - Last Name:FRYMIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASHLEY FRYMIRE COTA/
Mailing Address - Street 1:10751 VILLMER RD
Mailing Address - Street 2:
Mailing Address - City:CADET
Mailing Address - State:MO
Mailing Address - Zip Code:63630-9634
Mailing Address - Country:US
Mailing Address - Phone:314-309-8662
Mailing Address - Fax:
Practice Address - Street 1:10751 VILLMER RD
Practice Address - Street 2:
Practice Address - City:CADET
Practice Address - State:MO
Practice Address - Zip Code:63630-9634
Practice Address - Country:US
Practice Address - Phone:314-309-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013692224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty