Healthcare Provider Details

I. General information

NPI: 1285767178
Provider Name (Legal Business Name): HALEY ANN POITEVINT OT ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 3RD AVE
ALBANY GA
31701-1943
US

IV. Provider business mailing address

417 W 3RD AVE
ALBANY GA
31701-1943
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-4411
  • Fax: 229-312-1221
Mailing address:
  • Phone: 229-312-4411
  • Fax: 229-312-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA000864
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: