Provider Demographics
NPI:1376851535
Name:VAN HAASTEREN, ELLEN HANSEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:HANSEN
Last Name:VAN HAASTEREN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CARRIAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6157
Mailing Address - Country:US
Mailing Address - Phone:207-655-4282
Mailing Address - Fax:
Practice Address - Street 1:434 WEBBS MILLS RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071-6320
Practice Address - Country:US
Practice Address - Phone:207-655-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist