Healthcare Provider Details

I. General information

NPI: 1063329290
Provider Name (Legal Business Name): TRAVIS ASHLEY OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 600
TUBA CITY AZ
86045-0600
US

IV. Provider business mailing address

PO BOX 1582
GALLUP NM
87305-1582
US

V. Phone/Fax

Practice location:
  • Phone: 866-976-5941
  • Fax:
Mailing address:
  • Phone: 505-399-8146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: