Provider Demographics
NPI:1740708148
Name:MOODY, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:SELSTED-SIANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3474
Mailing Address - Country:US
Mailing Address - Phone:877-234-8032
Mailing Address - Fax:
Practice Address - Street 1:20330 N CAVE CREEK RD STE A150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4465
Practice Address - Country:US
Practice Address - Phone:602-765-4338
Practice Address - Fax:602-765-4761
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
AZ007568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist