Basic Information
Provider Information | |||||||||
NPI: | 1568478006 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HAYES | ||||||||
FirstName: | DONNA | ||||||||
MiddleName: | JEAN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, CTRS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 421 N MAIN ST | ||||||||
Address2: | REHABILITATION THERAPY | ||||||||
City: | LEEDS | ||||||||
State: | MA | ||||||||
PostalCode: | 010539764 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135844040 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 421 N MAIN ST | ||||||||
Address2: | REHABILITATION THERAPY | ||||||||
City: | LEEDS | ||||||||
State: | MA | ||||||||
PostalCode: | 010539764 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135844040 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225800000X | 16161 | NY | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 16161 | 01 | MA | RECREATION THERAPIST | OTHER |