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General NPI Number Information
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NPI Number | 1861181869
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Entity Type | Individual
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Provider Name | HALEY NICHOLE BEATTY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 5042 42ND ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33711-4720
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Country | US
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Telephone | 727-612-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 60TH ST S
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City | GULFPORT
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State | FL
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Zip | 33707-3205
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Country | US
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Telephone | 727-612-7115
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 24028
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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