Provider Demographics
NPI:1407367667
Name:WHITE, HAYLEY MAE (AT)
Entity type:Individual
Prefix:MISS
First Name:HAYLEY
Middle Name:MAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4671 REVOLUTIONARY WAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7570
Mailing Address - Country:US
Mailing Address - Phone:816-591-7336
Mailing Address - Fax:757-221-4361
Practice Address - Street 1:751 UKROP WAY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-221-3407
Practice Address - Fax:757-221-4361
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer