Provider Demographics
NPI:1285954370
Name:HAYWARD, THERESA CHILTON (BS OTR/L)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:CHILTON
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:BS OTR/L
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:CHILTON
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSOTR/L
Mailing Address - Street 1:4860 Y STREET
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-7039
Mailing Address - Fax:916-734-7144
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-7039
Practice Address - Fax:916-734-7144
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6303225X00000X, 225XG0600X, 225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics