Healthcare Provider Details

I. General information

NPI: 1982154431
Provider Name (Legal Business Name): ERIKA HALEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 LAKE HOLLOW BLVD SW
MARIETTA GA
30064-3947
US

IV. Provider business mailing address

6034 RICHMOND HWY APT 605
ALEXANDRIA VA
22303-2112
US

V. Phone/Fax

Practice location:
  • Phone: 571-882-0652
  • Fax:
Mailing address:
  • Phone: 571-882-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number0119007345
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number28695
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number08649
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: