Provider Demographics
NPI:1093227621
Name:HAYWARD, JUSTIN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HAYWARD
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19900 CLARE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1806
Mailing Address - Country:US
Mailing Address - Phone:216-662-3343
Mailing Address - Fax:216-662-1887
Practice Address - Street 1:19900 CLARE AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1806
Practice Address - Country:US
Practice Address - Phone:216-662-3343
Practice Address - Fax:216-662-1887
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OTA006782224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant