Provider Demographics
NPI:1316713084
Name:UNDERWOOD, ASHLEY (OTR)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:UNDERWOOD
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 1:1107 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-1476
Mailing Address - Country:US
Mailing Address - Phone:865-680-4297
Mailing Address - Fax:
Practice Address - Street 1:200 E BROADWAY AVE STE 150
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5761
Practice Address - Country:US
Practice Address - Phone:865-201-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7846225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist