MEDICARE: QIANA LACHELLE HAILEY

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	225000000X	Orthotic Fitter		NC

General Provider Information

NPI Number	:	1821964115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QIANA LACHELLE HAILEY

Provider Business Mailing Address
First Line	:	5023 MALIBU DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-1539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5023 MALIBU DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-1539
Country	:	US
Telephone Number	:	980-349-3823
Fax Number	:

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

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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Directions to “ QIANA LACHELLE HAILEY ” Practice Location

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