Provider Demographics
NPI:1235750217
Name:CONNOR, HAILEY ANN (ATC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ANN
Last Name:CONNOR
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 1:25 STODGE DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 INSTITUTE RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2247
Practice Address - Country:US
Practice Address - Phone:508-831-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12702255A2300X
MA29772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer