Provider Demographics
NPI:1639408057
Name:HATFIELD, HALEY LAYNE (MOT, OTR, MA, BCBA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LAYNE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:MOT, OTR, MA, BCBA
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3500 DEPAUW BOULEVARD
Mailing Address - Street 2:SUITE 3070
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:625 N UNION STREET
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-2907
Practice Address - Country:US
Practice Address - Phone:765-252-0530
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004776A225X00000X
103K00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-15211OtherBCBA CERTIFICATE
IN201225780Medicaid