Provider Demographics
NPI:1730637646
Name:WAHLER, HALEY LARAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LARAE
Last Name:WAHLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:LARAE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4709 51ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6024
Mailing Address - Country:US
Mailing Address - Phone:701-840-2276
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105234225X00000X
ND1496225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist