Provider Demographics
NPI:1639413065
Name:HAYNES, RACHEL LESLIE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LESLIE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 W BROWNSTONE CT SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-2027
Mailing Address - Country:US
Mailing Address - Phone:256-654-2477
Mailing Address - Fax:
Practice Address - Street 1:1858 W BROWNSTONE CT SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-2027
Practice Address - Country:US
Practice Address - Phone:256-654-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2679224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant