Provider Demographics
NPI:1396516027
Name:FARR, ASHLEY DEANN (LMBT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DEANN
Last Name:FARR
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 BAYLINER DR APT B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-7224
Mailing Address - Country:US
Mailing Address - Phone:919-917-1162
Mailing Address - Fax:
Practice Address - Street 1:4309 BAYLINER DR APT B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-7224
Practice Address - Country:US
Practice Address - Phone:919-917-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty