1134595911 NPI number — MRS. ASHLEY BROOKE BRANFORT OTR

Table of content: MRS. ASHLEY BROOKE BRANFORT OTR (NPI 1134595911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134595911 NPI number — MRS. ASHLEY BROOKE BRANFORT OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANFORT
Provider First Name:
ASHLEY
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134595911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1995 E COALTON RD
Provider Second Line Business Mailing Address:
APT. 76-103
Provider Business Mailing Address City Name:
SUPERIOR
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80027-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-614-3707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1995 E COALTON RD
Provider Second Line Business Practice Location Address:
APT. 76-103
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-614-3707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT.0004388 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com