Provider Demographics
NPI:1598511669
Name:LEAVER, HAYES ALLISON (OTR/L)
Entity type:Individual
Prefix:
First Name:HAYES
Middle Name:ALLISON
Last Name:LEAVER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 W IOWA ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4800
Mailing Address - Country:US
Mailing Address - Phone:941-504-3676
Mailing Address - Fax:
Practice Address - Street 1:2219 W IOWA ST APT 3R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4800
Practice Address - Country:US
Practice Address - Phone:941-504-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist