Provider Demographics
NPI:1073110045
Name:HAINES, RYAN BEEBE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:BEEBE
Last Name:HAINES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:RYAN
Other - Middle Name:KATHLEEN
Other - Last Name:BEEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:5025 WILLING CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-3103
Mailing Address - Country:US
Mailing Address - Phone:704-619-2873
Mailing Address - Fax:
Practice Address - Street 1:5025 WILLING CT
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-3103
Practice Address - Country:US
Practice Address - Phone:704-619-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist