Provider Demographics
NPI:1689333015
Name:ROSALES, ASHLEY A (MTBC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MTBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 SW SPRATT WAY APT 55
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-2485
Mailing Address - Country:US
Mailing Address - Phone:951-813-6970
Mailing Address - Fax:
Practice Address - Street 1:11830 KERR PKWY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1249
Practice Address - Country:US
Practice Address - Phone:951-813-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMT-T-10206912225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist