Provider Demographics
NPI:1447657168
Name:OGNENOVSKI, HALEY
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:
Last Name:OGNENOVSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LONG ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MO
Mailing Address - Zip Code:64660-8108
Mailing Address - Country:US
Mailing Address - Phone:660-734-8146
Mailing Address - Fax:
Practice Address - Street 1:401 LONG ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MO
Practice Address - Zip Code:64660-8108
Practice Address - Country:US
Practice Address - Phone:660-734-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014001724224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant