Individual
ELLEN R. HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3020 S 6TH ST, SPRINGFIELD, IL 62703-5915
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056009632
IL
Other
Enumeration date
10/01/2015
Last updated
05/22/2020
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