Provider Demographics
NPI:1124641170
Name:MEDLIN, HALEIGH (COTA/L, BT)
Entity type:Individual
Prefix:
First Name:HALEIGH
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:COTA/L, BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SOUTHGATE CORPORATE PARK SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1518
Mailing Address - Country:US
Mailing Address - Phone:828-358-3115
Mailing Address - Fax:
Practice Address - Street 1:1040 SOUTHGATE CORPORATE PARK SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1518
Practice Address - Country:US
Practice Address - Phone:828-358-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC13003224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician