Provider Demographics
NPI:1396384947
Name:HAYES, NATASHA LEA (ATC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LEA
Last Name:HAYES
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 1:6386 HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:SOSO
Mailing Address - State:MS
Mailing Address - Zip Code:39480-5053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:254 SPRINGHILL RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443-7874
Practice Address - Country:US
Practice Address - Phone:601-729-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT03682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer