Healthcare Provider Details

I. General information

NPI: 1740893742
Provider Name (Legal Business Name): HALEY PAIGE RUST OT-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8643 W CENTRAL AVE
WICHITA KS
67212-3614
US

IV. Provider business mailing address

1055 N 199TH ST W
GODDARD KS
67052-9131
US

V. Phone/Fax

Practice location:
  • Phone: 316-204-1259
  • Fax: 888-595-0755
Mailing address:
  • Phone: 316-204-1259
  • Fax: 888-595-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: