Provider Demographics
NPI:1073750535
Name:HAAG, LORI KAY (OTR/L, CLT-LANA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KAY
Last Name:HAAG
Suffix:
Gender:F
Credentials:OTR/L, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17012 COUNTY ROAD 43
Mailing Address - Street 2:
Mailing Address - City:EDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55329-9261
Mailing Address - Country:US
Mailing Address - Phone:320-453-3960
Mailing Address - Fax:
Practice Address - Street 1:200 W 1ST ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1445
Practice Address - Country:US
Practice Address - Phone:320-243-7704
Practice Address - Fax:320-243-7519
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102547225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation