Provider Demographics
NPI:1649990664
Name:PENDERGAST, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:PENDERGAST
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 1:62 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5014
Mailing Address - Country:US
Mailing Address - Phone:203-612-0515
Mailing Address - Fax:
Practice Address - Street 1:1839 ONSLOW DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5906
Practice Address - Country:US
Practice Address - Phone:910-455-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist