Healthcare Provider Details

I. General information

NPI: 1417642836
Provider Name (Legal Business Name): HALEY MUELLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY R HENKE OTR/L

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W RIVER WOODS PKWY STE 230
GLENDALE WI
53212-1010
US

IV. Provider business mailing address

525 W RIVER WOODS PKWY STE 230
GLENDALE WI
53212-1010
US

V. Phone/Fax

Practice location:
  • Phone: 414-453-7418
  • Fax: 414-967-1151
Mailing address:
  • Phone: 414-453-7418
  • Fax: 414-967-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8203-26
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number8203-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: