Provider Demographics
NPI:1013294073
Name:HAFNER, ROSALIE CAROL (OTR/L,WMMT,MFRP)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:CAROL
Last Name:HAFNER
Suffix:
Gender:F
Credentials:OTR/L,WMMT,MFRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 STAGS RUN
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9549
Mailing Address - Country:US
Mailing Address - Phone:231-526-7305
Mailing Address - Fax:231-242-0809
Practice Address - Street 1:150 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-1423
Practice Address - Country:US
Practice Address - Phone:231-838-0240
Practice Address - Fax:231-242-0809
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002818225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist