Provider Demographics
NPI:1740306760
Name:HALEY, COURTNEY ANNE (COTA-L)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ANNE
Last Name:HALEY
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 FARVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1575
Mailing Address - Country:US
Mailing Address - Phone:570-282-1117
Mailing Address - Fax:
Practice Address - Street 1:100 LYNWOOD AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2868
Practice Address - Country:US
Practice Address - Phone:570-346-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003110L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOP003110LOtherCOTA-L
PA1035238OtherCOTA-L