Healthcare Provider Details

I. General information

NPI: 1316631575
Provider Name (Legal Business Name): HAYLEE NICOLE MARSTELLER MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8309 ALLIE CAT WAY
SPOTSYLVANIA VA
22553-3679
US

IV. Provider business mailing address

8309 ALLIE CAT WAY
SPOTSYLVANIA VA
22553-3679
US

V. Phone/Fax

Practice location:
  • Phone: 913-704-7415
  • Fax:
Mailing address:
  • Phone: 913-704-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number0126002810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: