Provider Demographics
NPI:1740893742
Name:RUST, HALEY PAIGE (OT-R)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:PAIGE
Last Name:RUST
Suffix:
Gender:F
Credentials:OT-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 199TH ST W
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-9131
Mailing Address - Country:US
Mailing Address - Phone:316-204-1259
Mailing Address - Fax:888-595-0755
Practice Address - Street 1:8643 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3614
Practice Address - Country:US
Practice Address - Phone:316-204-1259
Practice Address - Fax:888-595-0755
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST-05323OtherKANSAS STATE BOARD OF HEALING ARTS