Provider Demographics
NPI:1659320232
Name:HAYNIE, LAUREN S (ATC)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:S
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2349 HAZELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4538
Mailing Address - Country:US
Mailing Address - Phone:301-638-3097
Mailing Address - Fax:202-319-4752
Practice Address - Street 1:620 MICHIGAN AVE NE
Practice Address - Street 2:108 DUFOUR CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20064-0001
Practice Address - Country:US
Practice Address - Phone:202-319-6049
Practice Address - Fax:202-319-4752
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer