Provider Demographics
NPI:1619165578
Name:HAAS, MELISSA (OTR, APSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:OTR, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3276
Mailing Address - Country:US
Mailing Address - Phone:715-210-8336
Mailing Address - Fax:
Practice Address - Street 1:725 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3399
Practice Address - Country:US
Practice Address - Phone:715-723-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131988-1211041C0700X
225XP0200X
WI3516-26225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40830000Medicaid