Provider Demographics
NPI:1568093755
Name:HAEGER, BREANNE MAY (OT)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:MAY
Last Name:HAEGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:MAY
Other - Last Name:HAEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:8755 AERO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1750
Mailing Address - Country:US
Mailing Address - Phone:619-578-2232
Mailing Address - Fax:
Practice Address - Street 1:8755 AERO DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1750
Practice Address - Country:US
Practice Address - Phone:619-578-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17665225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics