Provider Demographics
NPI:1336920933
Name:HAFNER, AIMEE MICHELLE
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:MICHELLE
Last Name:HAFNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 CLAIRE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3124
Mailing Address - Country:US
Mailing Address - Phone:412-973-2724
Mailing Address - Fax:
Practice Address - Street 1:999 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2082
Practice Address - Country:US
Practice Address - Phone:847-673-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057-001249224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant