Provider Demographics
NPI:1093207573
Name:HAUGEN, KARLEY ANNE (COTA)
Entity Type:Individual
Prefix:
First Name:KARLEY
Middle Name:ANNE
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 MURRAY LN W
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9743
Mailing Address - Country:US
Mailing Address - Phone:262-305-9580
Mailing Address - Fax:
Practice Address - Street 1:1169 MURRAY LN W
Practice Address - Street 2:
Practice Address - City:HUBERTUS
Practice Address - State:WI
Practice Address - Zip Code:53033-9743
Practice Address - Country:US
Practice Address - Phone:262-305-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5494-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant