Provider Demographics
NPI:1437846862
Name:FITZGERALD, HALEIGH RENEE' (COTA)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:RENEE'
Last Name:FITZGERALD
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 1:105 DOLEAC DR APT 721
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3124
Mailing Address - Country:US
Mailing Address - Phone:601-503-3715
Mailing Address - Fax:
Practice Address - Street 1:10040 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5499
Practice Address - Country:US
Practice Address - Phone:850-474-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant