Healthcare Provider Details

I. General information

NPI: 1831054931
Provider Name (Legal Business Name): HAILEY DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 S VAL VISTA DR
GILBERT AZ
85298-0091
US

IV. Provider business mailing address

PO BOX 591
GILBERT AZ
85299-0591
US

V. Phone/Fax

Practice location:
  • Phone: 480-590-6921
  • Fax:
Mailing address:
  • Phone: 989-254-3931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: