Provider Demographics
NPI:1700275591
Name:HAASIS, LYNDE (COTA)
Entity Type:Individual
Prefix:
First Name:LYNDE
Middle Name:
Last Name:HAASIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 CLAIRE LN
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3739
Mailing Address - Country:US
Mailing Address - Phone:217-725-5966
Mailing Address - Fax:
Practice Address - Street 1:10770 CLAIRE LN
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3739
Practice Address - Country:US
Practice Address - Phone:217-725-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000431224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant