Provider Demographics
NPI:1184269086
Name:FOTOPOULOS, HALEY (OTR/L)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:FOTOPOULOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:KINSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32036 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:LAKEMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60051-6113
Mailing Address - Country:US
Mailing Address - Phone:574-361-2455
Mailing Address - Fax:
Practice Address - Street 1:795 N RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2453
Practice Address - Country:US
Practice Address - Phone:847-438-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013329225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist