Provider Demographics
NPI:1861730913
Name:CLARK, ASHLEY DANELLE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DANELLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2678 E LEVEL GREEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-8554
Mailing Address - Country:US
Mailing Address - Phone:606-256-9875
Mailing Address - Fax:
Practice Address - Street 1:2678 E LEVEL GREEN RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-8554
Practice Address - Country:US
Practice Address - Phone:606-256-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist