Basic Information
Provider Information
NPI: 1861984734
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: HALEY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: OTD, OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3947 E COUNTY ROAD 400 S
Address2:  
City: BROWNSTOWN
State: IN
PostalCode: 472209559
CountryCode: US
TelephoneNumber: 8122164609
FaxNumber:  
Practice Location
Address1: 2701 CHESTNUT STATION CT
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402996395
CountryCode: US
TelephoneNumber: 8003351060
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2018
LastUpdateDate: 06/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X99086555AINY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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