Individual
HALEY ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2629 DEL PRADO BLVD S, CAPE CORAL, FL 33904-5769
(239) 574-4434
Mailing address
15155 PARKSIDE DR APT 3, FORT MYERS, FL 33908-5107
(518) 912-6033
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA19184
FL
Other
Enumeration date
04/21/2023
Last updated
04/21/2023
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