Individual
ASHLEY FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1031 LAKE COUNTRY DR, GREENSBORO, GA 30642-5157
(706) 549-1663
(706) 546-8792
Mailing address
1765 OLD WEST BROAD ST BLDG 2-200, ATHENS, GA 30606-2887
(706) 549-1663
(706) 546-8792
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006716
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14005428
CAQH NUMBER
—
Enumeration date
05/01/2017
Last updated
07/01/2025
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