Healthcare Provider Details

I. General information

NPI: 1851091284
Provider Name (Legal Business Name): HAILEY MARIE MIZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 MCGILL AVE
MOBILE AL
36604-1218
US

IV. Provider business mailing address

9130 SAINT ELMO CIR N
IRVINGTON AL
36544-2916
US

V. Phone/Fax

Practice location:
  • Phone: 251-476-6335
  • Fax:
Mailing address:
  • Phone: 228-369-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5797
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: