Provider Demographics
NPI:1720590417
Name:KING, HAYLIE
Entity Type:Individual
Prefix:
First Name:HAYLIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 KNOTT AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5489
Mailing Address - Country:US
Mailing Address - Phone:714-893-7399
Mailing Address - Fax:
Practice Address - Street 1:11205 KNOTT AVE STE E
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5489
Practice Address - Country:US
Practice Address - Phone:714-893-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17994225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT17994OtherBOARD OF OCCUPATIONAL THERAPY OF CALIFORNIA