Provider Demographics
NPI:1659494938
Name:HASKETT, JEFFREY SCOTT (MS, CPO,FAAOP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:HASKETT
Suffix:
Gender:M
Credentials:MS, CPO,FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E. KINGSTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4742
Mailing Address - Country:US
Mailing Address - Phone:704-375-2587
Mailing Address - Fax:704-333-4429
Practice Address - Street 1:120 E. KINGSTON AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4742
Practice Address - Country:US
Practice Address - Phone:704-375-2587
Practice Address - Fax:704-333-4429
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700966Medicaid
NC7795096Medicaid
0141350005Medicare ID - Type UnspecifiedOFFICE PROVIDER NUMBER