Provider Demographics
NPI:1336880228
Name:HALLEY, CATHERINE G (COTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:G
Last Name:HALLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BULL RUN
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3030
Mailing Address - Country:US
Mailing Address - Phone:251-325-8254
Mailing Address - Fax:
Practice Address - Street 1:650 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7864
Practice Address - Country:US
Practice Address - Phone:251-220-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5175224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant