Healthcare Provider Details

I. General information

NPI: 1861659674
Provider Name (Legal Business Name): SHEILA KATHLEEN HAY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MP 1317.6 ALASKA HIGHWAY
TOK AK
99780
US

IV. Provider business mailing address

PO BOX 247
TOK AK
99780-0247
US

V. Phone/Fax

Practice location:
  • Phone: 907-883-3646
  • Fax: 907-883-4077
Mailing address:
  • Phone: 907-883-3646
  • Fax: 907-883-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2008-1068
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: