MEDICARE: BETH HAINES

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	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1598207045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH HAINES

Provider Business Mailing Address
First Line	:	1936 THOMAS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 THOMAS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4528
Country	:	US
Telephone Number	:	602-390-5827
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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Directions to “ BETH HAINES ” Practice Location

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