Provider Demographics
NPI:1285002105
Name:HAITE, MITZI AIKO (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:AIKO
Last Name:HAITE
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:AIKO
Other - Last Name:DOUTHIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CLT
Mailing Address - Street 1:309 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1657
Mailing Address - Country:US
Mailing Address - Phone:402-452-1400
Mailing Address - Fax:
Practice Address - Street 1:910 S 40TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1827
Practice Address - Country:US
Practice Address - Phone:402-452-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1943225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist