Provider Demographics
NPI:1073345591
Name:MORRIS, HAELI SIERRA (CMT #95318)
Entity type:Individual
Prefix:
First Name:HAELI
Middle Name:SIERRA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:CMT #95318
Other - Prefix:
Other - First Name:HAELI
Other - Middle Name:SIERRA
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED NAME
Mailing Address - Street 1:330 BOHEMIAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9578
Mailing Address - Country:US
Mailing Address - Phone:510-600-2986
Mailing Address - Fax:
Practice Address - Street 1:FIRST STREET
Practice Address - Street 2:
Practice Address - City:OCCIDENTAL
Practice Address - State:CA
Practice Address - Zip Code:95465
Practice Address - Country:US
Practice Address - Phone:510-600-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist