Basic Information
| Provider Information | |||||||||
| NPI: | 1124405741 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HASKELL | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | N9394 FOUR LAKES RD | ||||||||
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| City: | WAUSAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541778575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207378331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 STONEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ISHPEMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498492921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064851073 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2015 | ||||||||
| LastUpdateDate: | 05/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | L759830 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.