Provider Demographics
NPI:1427467000
Name:GOLD KEY OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:GOLD KEY OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELZA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:304-777-0517
Mailing Address - Street 1:1405 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9164
Mailing Address - Country:US
Mailing Address - Phone:304-777-0517
Mailing Address - Fax:
Practice Address - Street 1:1405 ARCADIA DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9164
Practice Address - Country:US
Practice Address - Phone:304-777-0517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty