Provider Demographics
NPI:1487912986
Name:GAUVAIN, ASHLEIGH C (MED, ATC/L)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:C
Last Name:GAUVAIN
Suffix:
Gender:F
Credentials:MED, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COURTLAND AVE
Mailing Address - Street 2:#5A
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3494
Mailing Address - Country:US
Mailing Address - Phone:860-869-3933
Mailing Address - Fax:
Practice Address - Street 1:151 COURTLAND AVE
Practice Address - Street 2:#5A
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3494
Practice Address - Country:US
Practice Address - Phone:860-869-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0005232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer