Provider Demographics
NPI:1598986101
Name:HAYNES, ERICKA ESTER (OT)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:ESTER
Last Name:HAYNES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 N SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538-8809
Mailing Address - Country:US
Mailing Address - Phone:260-352-2109
Mailing Address - Fax:
Practice Address - Street 1:900 PROVIDENT DRIVE
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580
Practice Address - Country:US
Practice Address - Phone:574-371-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005047A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist