Provider Demographics
NPI:1740614544
Name:HALEY, COLETTE M (LMT)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:M
Last Name:HALEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 E WHITTIER ST
Mailing Address - Street 2:RM 6
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2638
Mailing Address - Country:US
Mailing Address - Phone:614-654-0654
Mailing Address - Fax:
Practice Address - Street 1:193 E WHITTIER ST
Practice Address - Street 2:RM 6
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2638
Practice Address - Country:US
Practice Address - Phone:614-654-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000217171100000X
OH33.015717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist