Healthcare Provider Details

I. General information

NPI: 1487248019
Provider Name (Legal Business Name): HALEY DUGAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 STATION PKWY NW
ANDOVER MN
55304-3341
US

IV. Provider business mailing address

PO BOX 411512
BOSTON MA
02241-1512
US

V. Phone/Fax

Practice location:
  • Phone: 763-755-4275
  • Fax:
Mailing address:
  • Phone: 866-448-9543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: