Provider Demographics
NPI:1255544078
Name:HAAG, PATRICIA (OT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HAAG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:111 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2197
Mailing Address - Country:US
Mailing Address - Phone:203-735-8336
Mailing Address - Fax:203-735-3704
Practice Address - Street 1:111 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2197
Practice Address - Country:US
Practice Address - Phone:203-735-8336
Practice Address - Fax:203-735-3704
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50PTSOUTHCT01OtherBCBS
CTANCII53OtherOXFORD HEALTHPLANS
CT50PTSOUTHCT01OtherBCBS