Provider Demographics
NPI:1447864566
Name:HAYES, JENNIE GRACE (MSOT)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:GRACE
Last Name:HAYES
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 CASTLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:HIMROD
Mailing Address - State:NY
Mailing Address - Zip Code:14842-9609
Mailing Address - Country:US
Mailing Address - Phone:585-760-9562
Mailing Address - Fax:
Practice Address - Street 1:350 PARRISH ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1731
Practice Address - Country:US
Practice Address - Phone:585-396-6050
Practice Address - Fax:585-396-6064
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist