Provider Demographics
NPI:1205626868
Name:HAUSCHILD, COLLIN
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:HAUSCHILD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 VAN VOORHIS RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0305
Mailing Address - Country:US
Mailing Address - Phone:845-428-2805
Mailing Address - Fax:
Practice Address - Street 1:3450 MONONGAHELA BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3043
Practice Address - Country:US
Practice Address - Phone:304-288-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0019182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer