Provider Demographics
NPI:1336865781
Name:HAYNES, CLARA ELANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:ELANE
Last Name:HAYNES
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 1:771 YOUNT RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-8239
Mailing Address - Country:US
Mailing Address - Phone:336-552-3714
Mailing Address - Fax:
Practice Address - Street 1:350 KINGS WAY RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-6631
Practice Address - Country:US
Practice Address - Phone:276-634-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0119009485225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist