Healthcare Provider Details

I. General information

NPI: 1588943377
Provider Name (Legal Business Name): KATHLEEN MARY HAESE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S 18TH ST
PLATTSMOUTH NE
68048-2056
US

IV. Provider business mailing address

14209 S 30TH AVE
BELLEVUE NE
68123-2694
US

V. Phone/Fax

Practice location:
  • Phone: 402-296-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1575
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: