Ashley Fountain
Individual provider Active NPI Occupational Therapist · Homer, GA
NPI 1104122977 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1104122977
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT009376 (OH)
- Practice address
- 425 Gardiner Rd
Homer, GA 30547-3006 - Phone
- (706) 658-7656
- NPI assigned
- Jan 26, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT005179 | GA | MD | Occupational Therapist |
| OT009376 | OH | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT005179 | GA | |
| Occupational Therapist | 225X00000X | OT009376 | OH | Yes |
Addresses
Primary practice location
425 Gardiner Rd
Homer, GA 30547-3006
Mailing address
425 Gardiner Rd
Homer, GA 30547-3006
Other practice location 1
3146 Highway 63
Homer, GA 30547-2335
Phone (706) 658-7656
Other providers in Homer, GA
- Charis Counseling and Consulting
- Community Sleep Solutions, LLC
- County of Banks
- Jamie Johnson Crawford
- Jo Ann Dodd
- Katelyn Taylor Gillespie
- Health Notice LLC
- Janice Rebecca Hill
- Homer Drugs LLC
- Homer Drugs, LLC
All providers in Homer, GA · Occupational Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.