Provider Demographics
NPI:1477206142
Name:BENNETT, HALEY NICOLE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 DAISY LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3720
Mailing Address - Country:US
Mailing Address - Phone:334-444-5740
Mailing Address - Fax:
Practice Address - Street 1:325 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5752
Practice Address - Country:US
Practice Address - Phone:910-920-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist