Basic Information
| Provider Information | |||||||||
| NPI: | 1790012219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENHAW | ||||||||
| FirstName: | ASHLEIGH | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 W. JACKSON STREET | ||||||||
| Address2: | SUITE F | ||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018539747 | ||||||||
| FaxNumber: | 6018984761 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 W. JACKSON STREET | ||||||||
| Address2: | SUITE F | ||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018539747 | ||||||||
| FaxNumber: | 6018984761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2009 | ||||||||
| LastUpdateDate: | 11/04/2009 | ||||||||
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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 | 225XP0200X | OT2328 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.