Provider Demographics
NPI:1285088179
Name:HAACK, BRUCE ALLAN (OTD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLAN
Last Name:HAACK
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13604 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2606
Mailing Address - Country:US
Mailing Address - Phone:360-931-1152
Mailing Address - Fax:360-397-6823
Practice Address - Street 1:13604 NE 42ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2606
Practice Address - Country:US
Practice Address - Phone:360-931-1152
Practice Address - Fax:360-397-6823
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist