Provider Demographics
NPI:1750876652
Name:ORT, ASHLEE JEAN (LAT, ATC)
Entity type:Individual
Prefix:MISS
First Name:ASHLEE
Middle Name:JEAN
Last Name:ORT
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67530 US HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-8552
Mailing Address - Country:US
Mailing Address - Phone:574-831-2184
Mailing Address - Fax:
Practice Address - Street 1:67530 US HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-8552
Practice Address - Country:US
Practice Address - Phone:574-831-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002868A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer