Provider Demographics
NPI:1447971502
Name:BLACKBURN, HALEY A (OTR/L)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:A
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3020
Mailing Address - Country:US
Mailing Address - Phone:859-321-6911
Mailing Address - Fax:
Practice Address - Street 1:2344 ELKHORN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2784
Practice Address - Country:US
Practice Address - Phone:859-788-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY280468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist