Individual
RENEE HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
733 N FLAG CHAPEL RD, JACKSON, MS 39209-2206
(601) 922-5530
Mailing address
733 N FLAG CHAPEL RD, JACKSON, MS 39209-2206
(601) 922-5530
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2100
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TA2100
MS STATE BOARD OF HEALTH
MS
Enumeration date
02/26/2008
Last updated
02/26/2008
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