Provider Demographics
NPI:1235452301
Name:HAYES, MYRNA LYNN
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:LYNN
Last Name:HAYES
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 1:495 KRAMER RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IL
Mailing Address - Zip Code:61415-9034
Mailing Address - Country:US
Mailing Address - Phone:309-833-4101
Mailing Address - Fax:309-836-1589
Practice Address - Street 1:525 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3313
Practice Address - Country:US
Practice Address - Phone:309-833-4101
Practice Address - Fax:309-836-1589
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057000925224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant