Provider Demographics
NPI:1033969274
Name:HAVERKAMP, VALERIE (OT/R)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:HAVERKAMP
Suffix:
Gender:F
Credentials:OT/R
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:BRUNGARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 KELLOGG LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KS
Mailing Address - Zip Code:66402-9462
Mailing Address - Country:US
Mailing Address - Phone:785-845-6152
Mailing Address - Fax:
Practice Address - Street 1:6300 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1013
Practice Address - Country:US
Practice Address - Phone:785-845-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-04163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist