MEDICARE: BROOKLYN MARIE HAFFER BA

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	222Q00000X	Developmental Therapist	G021378	WV

General Provider Information

NPI Number	:	1538021258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN MARIE HAFFER BA

Provider Business Mailing Address
First Line	:	250 OVERBY RD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25704-9212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 OVERBY RD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25704-9212
Country	:	US
Telephone Number	:	304-972-3255
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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