Provider Demographics
NPI:1407723315
Name:HAYWARD, TRACY (MA, ATC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, ATC
Mailing Address - Street 1:2015 W ELDORADO ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1099 W WOOD ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-2944
Practice Address - Country:US
Practice Address - Phone:217-420-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILREINSTATING0960035292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty