Provider Demographics
NPI:1871703124
Name:HAYES, KRISTINA VINCIK (LRT, CTRS)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:VINCIK
Last Name:HAYES
Suffix:
Gender:F
Credentials:LRT, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 BURNLEE PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3802
Mailing Address - Country:US
Mailing Address - Phone:919-389-6513
Mailing Address - Fax:
Practice Address - Street 1:1003 12TH ST
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1626
Practice Address - Country:US
Practice Address - Phone:919-575-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1439225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist