Healthcare Provider Details

I. General information

NPI: 1528977550
Provider Name (Legal Business Name): HALEY M KELLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GROVE ST
BALDWIN CITY KS
66006-9204
US

IV. Provider business mailing address

811 GROVE ST
BALDWIN CITY KS
66006-9204
US

V. Phone/Fax

Practice location:
  • Phone: 785-594-2909
  • Fax: 785-594-2923
Mailing address:
  • Phone: 785-594-2909
  • Fax: 785-594-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberT-06613
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: