Provider Demographics
NPI:1023309390
Name:THE HAILEY MAYZ FOUNDATION
Entity type:Organization
Organization Name:THE HAILEY MAYZ FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, OTR/L
Authorized Official - Phone:949-600-5437
Mailing Address - Street 1:22431 ANTONIO PKWY
Mailing Address - Street 2:SUITE B160-493
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2133
Mailing Address - Country:US
Mailing Address - Phone:949-600-5437
Mailing Address - Fax:949-600-5439
Practice Address - Street 1:29977 AVENIDA DE LAS BANDERAS
Practice Address - Street 2:
Practice Address - City:RANCH SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2133
Practice Address - Country:US
Practice Address - Phone:949-600-5437
Practice Address - Fax:949-600-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT-706225XP0200X, 225XF0002X
CA13109235Z00000X
CA254552251P0200X
CAOT706225XF0002X, 225XP0200X
CA16089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty