Provider Demographics
NPI:1578533907
Name:HASKINS, ANNE MICHELE (PHD, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MICHELE
Last Name:HASKINS
Suffix:
Gender:F
Credentials:PHD, 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:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-6002
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:701-780-1942
Practice Address - Street 1:1000 SOUTH COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58206-6002
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:701-780-1942
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102340225X00000X
ND709225X00000X
ND#709225XH1200X
MN#102340225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2379849OtherUNITED HEALTH CARE
MN694G3HAOtherBCBS
MN700A8AXOtherBCBS
ND25944OtherBCBS
1042277OtherPREFERRED ONE
ND50899Medicaid
64-05826OtherMEDICA
MN747655800OtherMEDICAL ASSISTANCE
HP40228OtherHEALTH PARTNERS
25944OtherNORIDIAN MUTUAL
MN967323700OtherMEDICAL ASSISTANCE
2379849OtherUNITED HEALTH CARE
711670Medicare ID - Type Unspecified
711289Medicare ID - Type Unspecified