Provider Demographics
NPI:1780190587
Name:MERMOLIA, ASHLEY (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MERMOLIA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S88W19381 TIMBERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-7860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 WOOD RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1133
Practice Address - Country:US
Practice Address - Phone:262-595-2164
Practice Address - Fax:262-595-2225
Is Sole Proprietor?:No
Enumeration Date:2017-12-17
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960052272255A2300X, 2255A2300X
WI2543-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer