Provider Demographics
NPI:1053880617
Name:POOKER, ASHLEY M (OTR)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:POOKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PENNSYLVANIA PL
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2165
Mailing Address - Country:US
Mailing Address - Phone:641-683-3372
Mailing Address - Fax:641-684-6602
Practice Address - Street 1:3 PENNSYLVANIA PL
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2165
Practice Address - Country:US
Practice Address - Phone:641-683-3372
Practice Address - Fax:641-684-6602
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist