Provider Demographics
NPI:1912780628
Name:WHITE, HAYLEY MICHELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:MICHELLE
Last Name:WHITE
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 1:207 BALFOUR RD
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1701
Mailing Address - Country:US
Mailing Address - Phone:870-270-0737
Mailing Address - Fax:
Practice Address - Street 1:207 BALFOUR RD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1701
Practice Address - Country:US
Practice Address - Phone:870-270-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1097224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant