Provider Demographics
NPI:1922651355
Name:BENFORD, ASHLEY (OTD/OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:BENFORD
Suffix:
Gender:F
Credentials:OTD/OTR/L
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:SINNAPPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-283-2501
Mailing Address - Fax:928-283-2095
Practice Address - Street 1:167 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:928-283-2095
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ568162Medicaid
AZTEZ7BPOtherMEDICARE