Basic Information
| Provider Information | |||||||||
| NPI: | 1699320853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIDDICK | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4712 OLD HIGHWAY 48 | ||||||||
| Address2: | |||||||||
| City: | CUNNINGHAM | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370524903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318017314 | ||||||||
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| Practice Location | |||||||||
| Address1: | 812 N CHARLOTTE ST | ||||||||
| Address2: | |||||||||
| City: | DICKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370551009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154468046 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2019 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3242 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.