Provider Demographics
NPI:1134595911
Name:BRANFORT, ASHLEY BROOKE (OTR)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BROOKE
Last Name:BRANFORT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:BROOKE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:1995 E COALTON RD
Mailing Address - Street 2:APT. 76-103
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4419
Mailing Address - Country:US
Mailing Address - Phone:785-614-3707
Mailing Address - Fax:
Practice Address - Street 1:1995 E COALTON RD
Practice Address - Street 2:APT. 76-103
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-4419
Practice Address - Country:US
Practice Address - Phone:785-614-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist