Healthcare Provider Details

I. General information

NPI: 1023545456
Provider Name (Legal Business Name): HALEY CUMMINGS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15116 N COTTON LN
SURPRISE AZ
85388-9618
US

IV. Provider business mailing address

1210 E BRIARWOOD TER
PHOENIX AZ
85048-8683
US

V. Phone/Fax

Practice location:
  • Phone: 800-376-3440
  • Fax:
Mailing address:
  • Phone: 480-707-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6906
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: