Provider Demographics
NPI:1841336807
Name:HAYNES, KATHLEEN WOLCOTT (OTR)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:WOLCOTT
Last Name:HAYNES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
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Mailing Address - Street 1:204 MERRIWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3853
Mailing Address - Country:US
Mailing Address - Phone:828-606-0295
Mailing Address - Fax:828-890-8941
Practice Address - Street 1:130 EAGLES REACH DRIVE
Practice Address - Street 2:DAVID SINK BLG-BRCC
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-4728
Practice Address - Country:US
Practice Address - Phone:828-692-7068
Practice Address - Fax:828-696-9722
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2022-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1376225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301024Medicaid