Healthcare Provider Details

I. General information

NPI: 1326383332
Provider Name (Legal Business Name): MARTHA JEAN HALEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA JEAN WERSOSKY OTR/L

II. Dates (important events)

Enumeration Date: 12/02/2012
Last Update Date: 12/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 ROCHESTER HILL RD
ROCHESTER NH
03867-3216
US

IV. Provider business mailing address

62 ROCHESTER HILL RD
ROCHESTER NH
03867-3216
US

V. Phone/Fax

Practice location:
  • Phone: 603-335-3955
  • Fax:
Mailing address:
  • Phone: 603-335-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0190
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: