Provider Demographics
NPI:1487134094
Name:HAILE, LENA LADELL (COTA)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:LADELL
Last Name:HAILE
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 1:11122 E STATE HWY 31
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144
Mailing Address - Country:US
Mailing Address - Phone:903-851-8456
Mailing Address - Fax:
Practice Address - Street 1:500 W 3RD AVE STE 6
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4564
Practice Address - Country:US
Practice Address - Phone:903-851-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209937224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant