Provider Demographics
NPI:1093477796
Name:HAYES, AMELIA CAROL (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:CAROL
Last Name:HAYES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16018 MORAN DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8715
Mailing Address - Country:US
Mailing Address - Phone:248-408-3774
Mailing Address - Fax:
Practice Address - Street 1:145 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1702
Practice Address - Country:US
Practice Address - Phone:269-792-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist