Provider Demographics
NPI:1902235682
Name:RAISOR, ASHLEY NICOLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:RAISOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:EKRON
Mailing Address - State:KY
Mailing Address - Zip Code:40117-7914
Mailing Address - Country:US
Mailing Address - Phone:270-501-0204
Mailing Address - Fax:
Practice Address - Street 1:1035 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:EKRON
Practice Address - State:KY
Practice Address - Zip Code:40117-7914
Practice Address - Country:US
Practice Address - Phone:270-501-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212411224Z00000X
KYA5652224ZF0002X
KY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & Swallowing
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYB07594491OtherDRIVERS LICENSE