Provider Demographics
NPI:1326861485
Name:HALEY, THOMAS ANTHONY JR
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:HALEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-2738
Mailing Address - Country:US
Mailing Address - Phone:614-961-9016
Mailing Address - Fax:
Practice Address - Street 1:571 HOLTZMAN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBU
Practice Address - State:OH
Practice Address - Zip Code:43320
Practice Address - Country:US
Practice Address - Phone:614-556-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator