Healthcare Provider Details

I. General information

NPI: 1811430960
Provider Name (Legal Business Name): HALEY OGBURN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WALLACE BLVD
AMARILLO TX
79106-1741
US

IV. Provider business mailing address

1250 WALLACE BLVD
AMARILLO TX
79106-1741
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-3596
  • Fax: 806-353-4927
Mailing address:
  • Phone: 806-353-3596
  • Fax: 806-353-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number117736
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: