Individual
WILLIAM OTIS HAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
770 E DUPONT RD, FORT WAYNE, IN 46825-2056
(260) 451-8242
Mailing address
9433 BOBCAT TRL, LEO, IN 46765-9360
(260) 437-4643
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
45023378A
IN
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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