=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013294073
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSALIE CAROL HAFNER OTR/L,WMMT,MFRP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2011
-----------------------------------------------------
Last Update Date | 11/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 W MAIN ST
-----------------------------------------------------
City | HARBOR SPRINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49740-1423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-838-0240
-----------------------------------------------------
Fax | 231-242-0809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 276 STAGS RUN
-----------------------------------------------------
City | HARBOR SPRINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49740-9549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-526-7305
-----------------------------------------------------
Fax | 231-242-0809
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5201002818
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------