MEDICARE: PAULINA HASELHORST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1205565785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINA HASELHORST

Provider Business Mailing Address
First Line	:	5119 N KENMORE AVE APT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-6454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5119 N KENMORE AVE APT 1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-6454
Country	:	US
Telephone Number	:	773-655-6648
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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Directions to “ PAULINA HASELHORST ” Practice Location

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