Healthcare Provider Details

I. General information

NPI: 1568263077
Provider Name (Legal Business Name): HALEY BEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 CASE ST
WEST GRANBY CT
06090-1509
US

IV. Provider business mailing address

59 CASE ST
WEST GRANBY CT
06090-1509
US

V. Phone/Fax

Practice location:
  • Phone: 860-478-3744
  • Fax:
Mailing address:
  • Phone: 860-478-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: