MEDICARE: JEAN CAROLINE HAASS OTR

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	225X00000X	Occupational Therapist	114834	TX

General Provider Information

NPI Number	:	1205191921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN CAROLINE HAASS OTR

Provider Business Mailing Address
First Line	:	4701 MONTEREY OAKS BLVD
Second Line	:	APT 1022
City	:	AUSTIN
State	:	TX
Zip	:	78749-1073
Country	:	US
Telephone Number	:	210-912-6322
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 WESTBANK DR
Second Line	:	STE 200
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6623
Country	:	US
Telephone Number	:	512-306-8007
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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