Provider Demographics
NPI:1972231835
Name:SPRAGUE, HAILEY NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:NICOLE
Last Name:SPRAGUE
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 1:35061 HOLT 285
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:MO
Mailing Address - Zip Code:64473-8293
Mailing Address - Country:US
Mailing Address - Phone:816-273-7542
Mailing Address - Fax:
Practice Address - Street 1:604 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-1147
Practice Address - Country:US
Practice Address - Phone:816-273-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021008097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist