MEDICARE: HAILEY DAVIDSON

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	225X00000X	Occupational Therapist	010249	AZ

General Provider Information

NPI Number	:	1831054931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY DAVIDSON

Provider Business Mailing Address
First Line	:	PO BOX 591
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85299-0591
Country	:	US
Telephone Number	:	989-254-3931
Fax Number	:

Provider Business Practice Location Address
First Line	:	4929 S VAL VISTA DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-0091
Country	:	US
Telephone Number	:	480-590-6921
Fax Number	:

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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Directions to “ HAILEY DAVIDSON ” Practice Location

Language	Start Address	Practice Location

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