MEDICARE: MICHELLE HAYWARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1376105643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HAYWARD

Provider Business Mailing Address
First Line	:	1 OLD ROUTE 89
Second Line	:
City	:	LEBANON
State	:	CT
Zip	:	06249-1133
Country	:	US
Telephone Number	:	203-815-3844
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 NORTH RD
Second Line	:
City	:	WINDHAM
State	:	CT
Zip	:	06280-1311
Country	:	US
Telephone Number	:	860-423-4636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	07/08/2019

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Directions to “ MICHELLE HAYWARD ” Practice Location

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