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General NPI Number Information
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NPI Number | 1952728271
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Entity Type | Individual
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Provider Name | HALEY BERRY LMT
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 266 SE 9TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-3023
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Country | US
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Telephone | 541-479-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 SW LOUISE CIR
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City | GRANTS PASS
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State | OR
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Zip | 97526-5842
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Country | US
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Telephone | 541-660-9398
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 19306
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License Number State | OR
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