Healthcare Provider Details

I. General information

NPI: 1629987458
Provider Name (Legal Business Name): HAYDEN WOOD OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

IV. Provider business mailing address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-2406
  • Fax: 478-832-6506
Mailing address:
  • Phone: 478-745-4206
  • Fax: 478-254-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT010076
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: