Provider Demographics
NPI:1487935250
Name:HAYFORD, LISAMARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:
Last Name:HAYFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3033
Mailing Address - Country:US
Mailing Address - Phone:607-797-5940
Mailing Address - Fax:
Practice Address - Street 1:3145 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3033
Practice Address - Country:US
Practice Address - Phone:607-797-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006429-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist