Healthcare Provider Details

I. General information

NPI: 1710802483
Provider Name (Legal Business Name): HAILEY DETERS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 SW 33RD ST
TOPEKA KS
66614-4635
US

IV. Provider business mailing address

5928 SW 53RD ST
TOPEKA KS
66610-9423
US

V. Phone/Fax

Practice location:
  • Phone: 785-408-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-01610
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: