Healthcare Provider Details

I. General information

NPI: 1215860010
Provider Name (Legal Business Name): HAILEY OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28110 128TH CT SE
KENT WA
98030-8501
US

IV. Provider business mailing address

28110 128TH CT SE
KENT WA
98030-8501
US

V. Phone/Fax

Practice location:
  • Phone: 425-757-0387
  • Fax:
Mailing address:
  • Phone: 425-757-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number605803390
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: