Provider Demographics
NPI:1639475577
Name:HAEN, JAMIE L (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:HAEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WREN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1717
Mailing Address - Country:US
Mailing Address - Phone:716-901-5651
Mailing Address - Fax:
Practice Address - Street 1:33 WREN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-1717
Practice Address - Country:US
Practice Address - Phone:716-901-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0113581172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker