Provider Demographics
NPI:1023717311
Name:BOSCH, ASHLEY CHRISTINE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHRISTINE
Last Name:BOSCH
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-0606
Mailing Address - Country:US
Mailing Address - Phone:217-722-1560
Mailing Address - Fax:
Practice Address - Street 1:1680 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:BUNCOMBE
Practice Address - State:IL
Practice Address - Zip Code:62912-2030
Practice Address - Country:US
Practice Address - Phone:217-722-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer