Provider Demographics
NPI:1336751528
Name:HOPPER, HALEY OWENS (OTR/L)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:OWENS
Last Name:HOPPER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 RIVER WATCH PKWY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3682
Mailing Address - Country:US
Mailing Address - Phone:706-364-3470
Mailing Address - Fax:706-496-7789
Practice Address - Street 1:3580 RIVER WATCH PKWY
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-3682
Practice Address - Country:US
Practice Address - Phone:706-364-3470
Practice Address - Fax:706-496-7789
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist