Provider Demographics
NPI:1659103075
Name:HAEFNER, EMILY (OT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HAEFNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 28TH ST APT 14N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8538
Mailing Address - Country:US
Mailing Address - Phone:414-581-8867
Mailing Address - Fax:
Practice Address - Street 1:201 E 28TH ST APT 14N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8538
Practice Address - Country:US
Practice Address - Phone:414-581-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027145-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist