Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 104500 | MN |
NPI | 1003240730 |
---|---|
Provider Name | Jaclyn Renee Haley |
First Address | St Paul Park, MN 55071-1249 |
Second Address | Hutchinson, MN 55350-5684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 29/08/2013 |