Healthcare Provider Details

I. General information

NPI: 1073132916
Provider Name (Legal Business Name): HALEY CHRISTINE O'HORA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15214 CANYON RD E STE 120
PUYALLUP WA
98375-7457
US

IV. Provider business mailing address

15214 CANYON RD E STE 120
PUYALLUP WA
98375-7457
US

V. Phone/Fax

Practice location:
  • Phone: 253-539-6078
  • Fax: 253-539-6045
Mailing address:
  • Phone: 253-539-6078
  • Fax: 253-539-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010204
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61521364
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: