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NPI Code Detail

MEDICARE: HALEY SHADDAY OTR

MEDICARE: HALEY SHADDAY OTR
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 Therapist5072CT

General Provider Information

NPI Number : 1366919169
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY SHADDAY OTR
Provider Business Mailing Address
First Line : 151 CEDAR ST
Second Line :
City : HOLLISTON
State : MA
Zip : 01746-1232
Country : US
Telephone Number : 401-595-0918
Fax Number :
Provider Business Practice Location Address
First Line : 2701 CHESTNUT STATION CT
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6395
Country : US
Telephone Number : 800-335-1060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2018
Last Update Date : 01/15/2026

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