Provider Demographics
NPI:1952578171
Name:HALLER, MAXINE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:
Last Name:HALLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 2944
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43086-2944
Mailing Address - Country:US
Mailing Address - Phone:614-537-7096
Mailing Address - Fax:614-754-5002
Practice Address - Street 1:56 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1700
Practice Address - Country:US
Practice Address - Phone:614-537-7096
Practice Address - Fax:614-754-5002
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 03830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist