Provider Demographics
NPI:1144874900
Name:BURKHAMMER, HALEY ELIZABETH (COTA/L)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ELIZABETH
Last Name:BURKHAMMER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:ROUNSAVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 WEST WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:AR
Mailing Address - Zip Code:72064
Mailing Address - Country:US
Mailing Address - Phone:870-255-5115
Mailing Address - Fax:
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-3046
Practice Address - Country:US
Practice Address - Phone:501-882-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1500224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty