Provider Demographics
NPI:1205191921
Name:HAASS, JEAN CAROLINE (OTR)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:CAROLINE
Last Name:HAASS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 MONTEREY OAKS BLVD
Mailing Address - Street 2:APT 1022
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1073
Mailing Address - Country:US
Mailing Address - Phone:210-912-6322
Mailing Address - Fax:
Practice Address - Street 1:925 WESTBANK DR
Practice Address - Street 2:STE 200
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6623
Practice Address - Country:US
Practice Address - Phone:512-306-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist