Provider Demographics
NPI:1699556316
Name:HAYES UNDERWOOD, CIEARA MARLENE (LMT)
Entity type:Individual
Prefix:
First Name:CIEARA
Middle Name:MARLENE
Last Name:HAYES UNDERWOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4065
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-0065
Mailing Address - Country:US
Mailing Address - Phone:330-333-8071
Mailing Address - Fax:
Practice Address - Street 1:8740 E MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2324
Practice Address - Country:US
Practice Address - Phone:330-716-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist