Basic Information
| Provider Information | |||||||||
| NPI: | 1578839403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 REALINI DR | ||||||||
| Address2: | |||||||||
| City: | HAVELOCK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285329403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526658819 | ||||||||
| FaxNumber: | 2522542705 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 REALINI DR | ||||||||
| Address2: | |||||||||
| City: | HAVELOCK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285329403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526658819 | ||||||||
| FaxNumber: | 2522542705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2012 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5321 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 018TE | 01 | NC | BLUE CROSS AND BLUE SHIELD | OTHER |