Healthcare Provider Details

I. General information

NPI: 1003240730
Provider Name (Legal Business Name): JACLYN RENEE HALEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN RENEE SCHRIBER NONE

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20288 HIGHWAY 15 N SUITE 100
HUTCHINSON MN
55350-5684
US

IV. Provider business mailing address

1660 LINCOLN AVE
ST PAUL PARK MN
55071-1249
US

V. Phone/Fax

Practice location:
  • Phone: 320-587-2326
  • Fax: 320-234-6358
Mailing address:
  • Phone: 218-791-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number104500
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: