Provider Demographics
NPI:1528857943
Name:HIGGINBOTHAM, HALEY BETH
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:BETH
Last Name:HIGGINBOTHAM
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 1:2753 SIMMONS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25015-9743
Mailing Address - Country:US
Mailing Address - Phone:304-859-0321
Mailing Address - Fax:
Practice Address - Street 1:2753 SIMMONS CREEK RD
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:WV
Practice Address - Zip Code:25015-9743
Practice Address - Country:US
Practice Address - Phone:304-859-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA2H144900231252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency