Provider Demographics
NPI:1285994475
Name:BREHM, ASHLEE (OTR)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:BREHM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 WOODSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 DAVIS RD
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777-9230
Practice Address - Country:US
Practice Address - Phone:260-622-7821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004807A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist