Basic Information
Provider Information | |||||||||
NPI: | 1962568071 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BATCHELDER | ||||||||
FirstName: | ASHLEY | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, LAT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | JONES | ||||||||
OtherFirstName: | ASHLEY | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MS, LAT | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 106 GLENFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | STRATFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 066144032 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2093134525 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 888 WHITE PLAINS RD | ||||||||
Address2: | SUITE 105 | ||||||||
City: | TRUMBULL | ||||||||
State: | CT | ||||||||
PostalCode: | 066114552 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2032682882 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/01/2007 | ||||||||
LastUpdateDate: | 04/17/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 000468 | CT | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.