Provider Demographics
NPI:1891526778
Name:MOLER, ASHLEY DENISE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DENISE
Last Name:MOLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 SHELDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3851
Mailing Address - Country:US
Mailing Address - Phone:719-290-6717
Mailing Address - Fax:
Practice Address - Street 1:1802 CHAPEL HILLS DR STE E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3736
Practice Address - Country:US
Practice Address - Phone:719-531-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022506225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist