Provider Demographics
NPI:1003240730
Name:HALEY, JACLYN RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:RENEE
Last Name:HALEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:RENEE
Other - Last Name:SCHRIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:1660 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ST PAUL PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55071-1249
Mailing Address - Country:US
Mailing Address - Phone:218-791-6246
Mailing Address - Fax:
Practice Address - Street 1:20288 HIGHWAY 15 N
Practice Address - Street 2:SUITE 100
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-5684
Practice Address - Country:US
Practice Address - Phone:320-587-2326
Practice Address - Fax:320-234-6358
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104500225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics