Healthcare Provider Details

I. General information

NPI: 1457272049
Provider Name (Legal Business Name): ALEXIS ERIN HAYNES OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 S HALCYON RD
ARROYO GRANDE CA
93420-3817
US

IV. Provider business mailing address

520 SNOWBIRD LN
CORONA CA
92882-5978
US

V. Phone/Fax

Practice location:
  • Phone: 805-489-4261
  • Fax:
Mailing address:
  • Phone: 951-500-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: