Provider Demographics
NPI:1487233706
Name:HORACK, AINSLEY (OTR/L)
Entity type:Individual
Prefix:
First Name:AINSLEY
Middle Name:
Last Name:HORACK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 TANGLEFOOT LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1740
Mailing Address - Country:US
Mailing Address - Phone:515-419-4920
Mailing Address - Fax:
Practice Address - Street 1:1455 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1834
Practice Address - Country:US
Practice Address - Phone:309-865-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089964225X00000X
225X00000X
IL056011172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist