=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528625597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEY LOGAN SMITH OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2019
-----------------------------------------------------
Last Update Date | 05/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6814 SOBBIE RD
-----------------------------------------------------
City | PLEASANT VALLEY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068-9555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-781-5277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9824 N OVERTON ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64157-7768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-304-6592
-----------------------------------------------------
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 | 2019013665
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------