Provider Demographics
NPI:1356404040
Name:HAYFORD, AMY LEANNE (ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEANNE
Last Name:HAYFORD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-1064
Mailing Address - Country:US
Mailing Address - Phone:517-486-6248
Mailing Address - Fax:
Practice Address - Street 1:4848 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2170
Practice Address - Country:US
Practice Address - Phone:419-824-1323
Practice Address - Fax:419-885-5179
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer