Provider Demographics
NPI:1578839403
Name:HAYES, TRACY L (OTR/L)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
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 1:118 REALINI DR
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-9403
Mailing Address - Country:US
Mailing Address - Phone:252-665-8819
Mailing Address - Fax:252-254-2705
Practice Address - Street 1:118 REALINI DR
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-9403
Practice Address - Country:US
Practice Address - Phone:252-665-8819
Practice Address - Fax:252-254-2705
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018TEOtherBLUE CROSS AND BLUE SHIELD