Provider Demographics
NPI:1033697222
Name:HAFFNER, ASHLEY MARIAH (BS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIAH
Last Name:HAFFNER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ASHELY
Other - Middle Name:MARIAH
Other - Last Name:HORNADAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:765-454-9759
Practice Address - Street 1:3771 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6053
Practice Address - Country:US
Practice Address - Phone:765-598-4197
Practice Address - Fax:765-454-9759
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006694A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist