Provider Demographics
NPI:1588937940
Name:HODGE, ASHLEY FOWLER (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FOWLER
Last Name:HODGE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2310
Mailing Address - Country:US
Mailing Address - Phone:843-310-9689
Mailing Address - Fax:800-317-9690
Practice Address - Street 1:1004 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2310
Practice Address - Country:US
Practice Address - Phone:843-310-9689
Practice Address - Fax:800-317-9690
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist