Provider Demographics
NPI:1417191446
Name:HAAS, KATHRYN GRACE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:HAAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:GRACE
Other - Last Name:DESIMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2600 LOVEJOY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4111
Mailing Address - Country:US
Mailing Address - Phone:907-441-5837
Mailing Address - Fax:
Practice Address - Street 1:3330 EAGLE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4146
Practice Address - Country:US
Practice Address - Phone:907-887-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1499225X00000X
CA9600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist