Healthcare Provider Details

I. General information

NPI: 1033494844
Provider Name (Legal Business Name): HAYLEY A BROOKS-WALLIN OTR/L, SI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 SAND PIT RD
DANBURY CT
06810-4004
US

IV. Provider business mailing address

6 FARVIEW TER
DANBURY CT
06811-5104
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-5631
  • Fax: 203-207-3194
Mailing address:
  • Phone: 203-790-5752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002177
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: