Provider Demographics
NPI:1285976035
Name:HAYNES, STEVEN J (COTA/L)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:HAYNES
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 W HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3761
Mailing Address - Country:US
Mailing Address - Phone:208-447-0833
Mailing Address - Fax:
Practice Address - Street 1:13609 CALIFORNIA STREET, SUITE 200
Practice Address - Street 2:C&A PLAZA, AUREUS MEDICAL GROUP
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5260
Practice Address - Country:US
Practice Address - Phone:402-891-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60269501224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant