Individual
MRS. ANITA MARIE HAYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
383 W TEMPLE ST, WAVERLY, IL 62692-1066
(217) 556-5001
Mailing address
383 W TEMPLE ST, WAVERLY, IL 62692-1066
(217) 556-5001
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
IL
Enumeration date
02/27/2019
Last updated
02/27/2019
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