Provider Demographics
NPI:1770863722
Name:HAYWARD, KRISTIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HAYWARD
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 1:2017 LAKE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9329
Mailing Address - Country:US
Mailing Address - Phone:803-315-5394
Mailing Address - Fax:
Practice Address - Street 1:5100 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4768
Practice Address - Country:US
Practice Address - Phone:704-554-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7987225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist