Provider Demographics
NPI:1902341332
Name:ZIETZ, HALEY (OTRL)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:ZIETZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:CROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:415 MUNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3059
Mailing Address - Country:US
Mailing Address - Phone:231-486-6330
Mailing Address - Fax:231-486-6329
Practice Address - Street 1:415 MUNSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3059
Practice Address - Country:US
Practice Address - Phone:231-486-6330
Practice Address - Fax:231-486-6329
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI5201010098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician