Provider Demographics
NPI:1659404523
Name:HAYNES, JILLIAN (OTR)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:MURAWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:107 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2660
Mailing Address - Country:US
Mailing Address - Phone:413-219-1283
Mailing Address - Fax:
Practice Address - Street 1:462 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1833
Practice Address - Country:US
Practice Address - Phone:413-335-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9074225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist