MEDICARE: AIMEE MICHELLE HAFNER

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	057-001249	IL

General Provider Information

NPI Number	:	1336920933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE MICHELLE HAFNER

Provider Business Mailing Address
First Line	:	339 CLAIRE LN
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-3124
Country	:	US
Telephone Number	:	412-973-2724
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 W MAIN ST
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-2082
Country	:	US
Telephone Number	:	847-673-4110
Fax Number	:

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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