MEDICARE: DR. VICKI HAYWOOD DOE PHD

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	224Y00000X	Clinical Exercise Physiologist

General Provider Information

NPI Number	:	1437892130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI HAYWOOD DOE PHD

Provider Business Mailing Address
First Line	:	6004 YOUNGSTOWN WARREN RD # 1019
Second Line	:
City	:	NILES
State	:	OH
Zip	:	44446-4603
Country	:	US
Telephone Number	:	234-813-4304
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 W BROAD ST # 1270
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-2759
Country	:	US
Telephone Number	:	234-813-4304
Fax Number	:

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

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	07/21/2023

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