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NPI Code Detail

MEDICARE: HALEY DOUGLAS KIDD MIDDLETON OTR/L

MEDICARE: HALEY DOUGLAS KIDD MIDDLETON OTR/L
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 Therapist174692KY

General Provider Information

NPI Number : 1699285957
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY DOUGLAS KIDD MIDDLETON OTR/L
Provider Business Mailing Address
First Line : 2150 LEXINGTON RD STE G
Second Line :
City : RICHMOND
State : KY
Zip : 40475-7924
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1043 BROOKLYN BLVD
Second Line :
City : BEREA
State : KY
Zip : 40403-1090
Country : US
Telephone Number : 859-228-0551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2017
Last Update Date : 07/19/2023

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Directions to “ HALEY DOUGLAS KIDD MIDDLETON OTR/L” Practice Location

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