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NPI Code Detail

MEDICARE: HALEY ELLISON

MEDICARE: HALEY ELLISON
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
1225X00000XOccupational Therapist22004FL

General Provider Information

NPI Number : 1306597133
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY ELLISON
Provider Business Mailing Address
First Line : 7401 DIEHL CT
Second Line :
City : LOUISVILLE
State : KY
Zip : 40220-2198
Country : US
Telephone Number : 502-552-4472
Fax Number :
Provider Business Practice Location Address
First Line : 401 N ALF COLEMAN RD
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32407-2567
Country : US
Telephone Number : 850-249-2004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2022
Last Update Date : 01/13/2022

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Directions to “ HALEY ELLISON ” Practice Location

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