Provider Demographics
NPI:1386232825
Name:HAYNES, BENJAMIN T (OTD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:T
Last Name:HAYNES
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8060 E GIRARD AVE APT 502
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4418
Mailing Address - Country:US
Mailing Address - Phone:931-801-6908
Mailing Address - Fax:
Practice Address - Street 1:8060 E GIRARD AVE APT 502
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4418
Practice Address - Country:US
Practice Address - Phone:931-801-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006701225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics