Provider Demographics
NPI:1487248183
Name:FOURNIER, ASHLEY D
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BETTY RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2623
Mailing Address - Country:US
Mailing Address - Phone:860-712-6740
Mailing Address - Fax:
Practice Address - Street 1:807 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-2067
Practice Address - Country:US
Practice Address - Phone:413-782-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001176224Z00000X
MA3907224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001776OtherDEPARTMENT OF PUBIC HEALTH
MA3907OtherALLIED PROFESSIONAL HEALTH