Healthcare Provider Details

I. General information

NPI: 1437073202
Provider Name (Legal Business Name): HALEY BIRD OTDR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 BROAD ST
GRINNELL IA
50112-2153
US

IV. Provider business mailing address

2307 F15 BLVD
MARENGO IA
52301-8767
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-2953
  • Fax:
Mailing address:
  • Phone: 319-213-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number140498
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: