MEDICARE: ANDY H HASKIN OTA

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	224ZE0001X	Environmental Modification Occupational Therapy Assistant	208481	TX
2	224Z00000X	Occupational Therapy Assistant	208481	TX

General Provider Information

NPI Number	:	1609358092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDY H HASKIN OTA

Provider Business Mailing Address
First Line	:	1524 CHURCHILL DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-1376
Country	:	US
Telephone Number	:	940-566-2650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 CHURCHILL DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-1376
Country	:	US
Telephone Number	:	940-566-2650
Fax Number	:

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

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	08/31/2018

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Directions to “ ANDY H HASKIN OTA” Practice Location

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