Provider Demographics
NPI:1376156521
Name:WOLFE, HAILEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:WOLFE
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 1:1108 S MAIN ST UNIT 247
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3369
Mailing Address - Country:US
Mailing Address - Phone:513-403-9958
Mailing Address - Fax:
Practice Address - Street 1:1108 S MAIN ST UNIT 247
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3369
Practice Address - Country:US
Practice Address - Phone:513-403-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5864225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation