=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215875539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. DAMIEN JOEL HASELEY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2026
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 ONTARIO ST
-----------------------------------------------------
City | PHELPS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14532-1029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-220-5765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 962 W HILL RD
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12197-2217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 020051
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------