Provider Demographics
NPI:1649004763
Name:BRANTLEY, ASHLEY SADE (IP, PRS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SADE
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:IP, PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 SHOSHONE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-1161
Mailing Address - Country:US
Mailing Address - Phone:330-618-0943
Mailing Address - Fax:
Practice Address - Street 1:873 SHOSHONE AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-1161
Practice Address - Country:US
Practice Address - Phone:330-618-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X, 175T00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist