Provider Demographics
NPI:1093210411
Name:BERGHOEFER, HALEY JOYCE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:JOYCE
Last Name:BERGHOEFER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SILVER MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4734
Mailing Address - Country:US
Mailing Address - Phone:319-371-4411
Mailing Address - Fax:
Practice Address - Street 1:13550 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5812
Practice Address - Country:US
Practice Address - Phone:319-371-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018008827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist