MEDICARE: HAILEY OTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula	605803390	WA

General Provider Information

NPI Number	:	1215860010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY OTA

Provider Business Mailing Address
First Line	:	28110 128TH CT SE
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98030-8501
Country	:	US
Telephone Number	:	425-757-0387
Fax Number	:

Provider Business Practice Location Address
First Line	:	28110 128TH CT SE
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98030-8501
Country	:	US
Telephone Number	:	425-757-0387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ HAILEY OTA ” Practice Location

Language	Start Address	Practice Location

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