Provider Demographics
NPI:1831357409
Name:MARY B HALDY & ASSOCIATES, INC
Entity type:Organization
Organization Name:MARY B HALDY & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALDY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:303-404-3670
Mailing Address - Street 1:2000 W 120TH AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2470
Mailing Address - Country:US
Mailing Address - Phone:303-404-3670
Mailing Address - Fax:
Practice Address - Street 1:2000 W 120TH AVE
Practice Address - Street 2:STE 3
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2470
Practice Address - Country:US
Practice Address - Phone:303-404-3670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07000417Medicaid