Provider Demographics
NPI:1851704068
Name:HAYNES, WILLIE JAMES (OTR/L)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:JAMES
Last Name:HAYNES
Suffix:
Gender:M
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 1:5231 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2702
Mailing Address - Country:US
Mailing Address - Phone:301-229-1900
Mailing Address - Fax:301-229-1946
Practice Address - Street 1:10TH MEDICAL GROUP
Practice Address - Street 2:4102 PINION DRIVE
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840
Practice Address - Country:US
Practice Address - Phone:719-333-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist