Provider Demographics
NPI:1922829241
Name:WHITE, HALEY EMMA
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:EMMA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MERRIMACK ST UNIT 505
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1739
Mailing Address - Country:US
Mailing Address - Phone:603-834-0793
Mailing Address - Fax:
Practice Address - Street 1:24 MERRIMACK ST UNIT 505
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1739
Practice Address - Country:US
Practice Address - Phone:603-834-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15496225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist