Provider Demographics
NPI:1861930638
Name:GODDARD-CARTER, ASHLYNN DANIELLE (OTL)
Entity type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:DANIELLE
Last Name:GODDARD-CARTER
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR
Mailing Address - Street 2:STE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:65242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1205 JOHNSON FERRY RD
Practice Address - Street 2:STE 130
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5418
Practice Address - Country:US
Practice Address - Phone:770-565-3201
Practice Address - Fax:770-565-3203
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4493225X00000X
GAOT006439225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist