Active NPI
Ashley Russell
- Occupational Therapist
- Niceville, FL
National Provider Identifier
1013588151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4301
- Practice address
- 80 College Blvd E
Niceville, FL 32578-1343 - Phone
- (850) 279-3000
- Fax
- (850) 389-2269
- NPI assigned
- Jul 9, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 21-174813 | FL | |
| Occupational Therapist | 225X00000X | 4301 | AL | Primary |
Addresses
Primary practice location
80 College Blvd E
Niceville, FL 32578-1343
Mailing address
80 College Blvd E
Niceville, FL 32578-1343
Phone (850) 279-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21-174813 | FL | MD | Behavior Technician |
| 4301 | AL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emerald Coast Autism Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Niceville, FL
- NPI 1972030617
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1013588151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 COLLEGE BLVD E",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325781343",
"telephone_number": "850-279-3000",
"fax_number": "850-389-2269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 COLLEGE BLVD E",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325781343",
"telephone_number": "850-279-3000",
"fax_number": "850-389-2269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ASHLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-09",
"last_updated": "2023-11-27",
"certification_date": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "21-174813",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AL",
"license": "4301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.