Individual
ELIZABETH RACETTE HALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1215 E ORANGE ST, LAKELAND, FL 33801-5762
(863) 802-3800
(863) 802-0480
Mailing address
6602 ENGLELAKE DR, LAKELAND, FL 33813-3773
(863) 529-5951
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
14831
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004084800
—
FL
01
—
Z03MB
BCBS
FL
Enumeration date
09/09/2011
Last updated
01/30/2012
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