Provider Demographics
NPI:1184297962
Name:RICHARDSON, ASHLYN RENAE (OTR)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:RENAE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 MANTRA CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9672
Mailing Address - Country:US
Mailing Address - Phone:304-906-7764
Mailing Address - Fax:
Practice Address - Street 1:195 SPRINGBROOK AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8105
Practice Address - Country:US
Practice Address - Phone:919-550-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14247225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist