Provider Demographics
NPI:1679206486
Name:MATTES, ASHLEY (COTA/L)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MATTES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:DOLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28 MINERAL CT
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6071
Mailing Address - Country:US
Mailing Address - Phone:919-390-4827
Mailing Address - Fax:
Practice Address - Street 1:1014 ADAMS POINT DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6575
Practice Address - Country:US
Practice Address - Phone:919-359-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15099224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant