Individual
MRS. ASHLEY NICOLE RAISOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1035 OSBORNE RD, EKRON, KY 40117-7914
(270) 501-0204
Mailing address
1035 OSBORNE RD, EKRON, KY 40117-7914
(270) 501-0204
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
212411
TX
224Z00000X
Occupational Therapy Assistant
Primary
—
KY
224ZF0002X
Feeding, Eating & Swallowing Occupational Therapy Assistant
A5652
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B07594491
DRIVERS LICENSE
KY
Enumeration date
11/04/2013
Last updated
10/21/2021
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