Provider Demographics
NPI:1194112714
Name:NORDIN, ASHLEY (MS, LAT/ATC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:NORDIN
Suffix:
Gender:F
Credentials:MS, LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2725
Mailing Address - Country:US
Mailing Address - Phone:479-886-1021
Mailing Address - Fax:
Practice Address - Street 1:1425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2214
Practice Address - Country:US
Practice Address - Phone:870-741-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 5562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer