Provider Demographics
NPI:1144205774
Name:HAUGAN, RUTH A (ATC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:HAUGAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 STANFORD DR
Mailing Address - Street 2:APT. 16-B
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-5712
Mailing Address - Country:US
Mailing Address - Phone:662-844-2241
Mailing Address - Fax:
Practice Address - Street 1:4381 S EASON BLVD
Practice Address - Street 2:LONGTOWN MEDICAL PARK - ORC
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6583
Practice Address - Country:US
Practice Address - Phone:662-377-5468
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT03792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer