Healthcare Provider Details

I. General information

NPI: 1649004763
Provider Name (Legal Business Name): ASHLEY SADE BRANTLEY IP, PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 SHOSHONE AVE
AKRON OH
44305-1161
US

IV. Provider business mailing address

873 SHOSHONE AVE
AKRON OH
44305-1161
US

V. Phone/Fax

Practice location:
  • Phone: 330-618-0943
  • Fax:
Mailing address:
  • Phone: 330-618-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: