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General NPI Number Information
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NPI Number | 1548859861
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Entity Type | Individual
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Provider Name | HALEY RENEE GEORGE
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 2900 W 3RD ST
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City | ELK CITY
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State | OK
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Zip | 73644-4324
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Country | US
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Telephone | 580-243-0939
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 451
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City | ELK CITY
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State | OK
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Zip | 73648-0451
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Country | US
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Telephone | 802-430-9395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 001318
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 1318
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License Number State | OK
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