Provider Demographics
NPI:1962047068
Name:ANTHONY, ASHLEY DAJAY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAJAY
Last Name:ANTHONY
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 1:18927 BARBARA CT
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3601
Mailing Address - Country:US
Mailing Address - Phone:773-931-6119
Mailing Address - Fax:
Practice Address - Street 1:8200 185TH ST STE AB
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9232
Practice Address - Country:US
Practice Address - Phone:708-580-0440
Practice Address - Fax:708-263-0067
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056013256225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty