MEDICARE: ASHTON BENTLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		OK

General Provider Information

NPI Number	:	1538002373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHTON BENTLEY

Provider Business Mailing Address
First Line	:	1445 E OMAHA ST APT B5
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-0311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 W KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8948
Country	:	US
Telephone Number	:	918-805-6971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ ASHTON BENTLEY ” Practice Location

Language	Start Address	Practice Location

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