Provider Demographics
NPI:1003809690
Name:VOLLKOMMER-HALEY, URSULA (ATC)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:VOLLKOMMER-HALEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SOKOKIS TRL N
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-3106
Mailing Address - Country:US
Mailing Address - Phone:207-831-6641
Mailing Address - Fax:
Practice Address - Street 1:40 E EMERSON CUMMINGS BLVD
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1460
Practice Address - Country:US
Practice Address - Phone:207-934-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer