Provider Demographics
NPI:1407284417
Name:HAFNER, CARINA LEA (OT)
Entity Type:Individual
Prefix:MS
First Name:CARINA
Middle Name:LEA
Last Name:HAFNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:CARINA
Other - Middle Name:LEA
Other - Last Name:HERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 CRANBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5216
Mailing Address - Country:US
Mailing Address - Phone:715-393-3990
Mailing Address - Fax:715-393-3902
Practice Address - Street 1:3301 CRANBERRY BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5216
Practice Address - Country:US
Practice Address - Phone:715-393-3990
Practice Address - Fax:715-393-3902
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5301-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5301-26OtherWI STATE LICENSE