Individual
MRS. ASHLEY RENE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
20 RUSSELL BLVD, BRADFORD, PA 16701-3247
(814) 262-2621
(814) 262-1066
Mailing address
20 RUSSELL BLVD, BRADFORD, PA 16701-3247
(814) 362-1462
(814) 362-1066
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OC009615
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1017154660001
MA PROVIDER NUMBER
PA
Enumeration date
01/07/2013
Last updated
01/07/2013
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