Provider Demographics
NPI:1699519934
Name:HERBST, HALEY LERAE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:LERAE
Last Name:HERBST
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:LERAE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1619 HIGHWAY AA
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7065
Mailing Address - Country:US
Mailing Address - Phone:573-631-5558
Mailing Address - Fax:
Practice Address - Street 1:801 BRIM ST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3441
Practice Address - Country:US
Practice Address - Phone:573-431-0223
Practice Address - Fax:573-431-8984
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021043443225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist