Provider Demographics
NPI:1043764475
Name:DARTLONE, HALEY ELAINE (COTA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ELAINE
Last Name:DARTLONE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16954 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:SONDHEIMER
Mailing Address - State:LA
Mailing Address - Zip Code:71276-7623
Mailing Address - Country:US
Mailing Address - Phone:318-669-6719
Mailing Address - Fax:870-265-2525
Practice Address - Street 1:16954 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:SONDHEIMER
Practice Address - State:LA
Practice Address - Zip Code:71276-7623
Practice Address - Country:US
Practice Address - Phone:318-669-6719
Practice Address - Fax:870-265-2525
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist