Provider Demographics
NPI:1851426373
Name:HAYES, WANDA A (COTAL)
Entity Type:Individual
Prefix:MISS
First Name:WANDA
Middle Name:A
Last Name:HAYES
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 WYMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3914
Mailing Address - Country:US
Mailing Address - Phone:216-541-3611
Mailing Address - Fax:
Practice Address - Street 1:1275 LAKESIDE AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1132
Practice Address - Country:US
Practice Address - Phone:216-241-8320
Practice Address - Fax:216-861-0253
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA00627224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant