Healthcare Provider Details

I. General information

NPI: 1477206142
Provider Name (Legal Business Name): HALEY NICOLE BENNETT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ALEXANDER ST
FAYETTEVILLE NC
28301-5752
US

IV. Provider business mailing address

1729 DAISY LN
FAYETTEVILLE NC
28303-3720
US

V. Phone/Fax

Practice location:
  • Phone: 910-920-3838
  • Fax:
Mailing address:
  • Phone: 334-444-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14743
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: