Provider Demographics
NPI:1275834764
Name:HAUTMAN, ANTHONY JAY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAY
Last Name:HAUTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6841 ROMAINE RD
Mailing Address - Street 2:
Mailing Address - City:POSEYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47633-8826
Mailing Address - Country:US
Mailing Address - Phone:812-205-9994
Mailing Address - Fax:
Practice Address - Street 1:1712 N LELAND DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9348
Practice Address - Country:US
Practice Address - Phone:812-683-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99044746A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist