Provider Demographics
NPI:1528438108
Name:WATKINS, HALEY ELISE TUCKER (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:ELISE TUCKER
Last Name:WATKINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:ELISE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 BLYTHE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5814
Mailing Address - Country:US
Mailing Address - Phone:704-355-4645
Mailing Address - Fax:704-355-4541
Practice Address - Street 1:561 N POLK ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8563
Practice Address - Country:US
Practice Address - Phone:704-667-8470
Practice Address - Fax:704-667-8471
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9991225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics