Healthcare Provider Details

I. General information

NPI: 1083216725
Provider Name (Legal Business Name): HAYLEY KRISTINE SIMONS AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARK AVE
ELYRIA OH
44035-6457
US

IV. Provider business mailing address

521 PARK AVE
ELYRIA OH
44035-6457
US

V. Phone/Fax

Practice location:
  • Phone: 440-458-0775
  • Fax:
Mailing address:
  • Phone: 440-458-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006813
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: