Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00001678 | WA |
N | 225XH1200X | Occupational Therapist - Hand | OT00001678 | WA |
NPI | 1184634578 |
---|---|
Provider Name | Joanne M. Haberman |
First Address | Seattle, WA 98104-2420 |
Second Address | Seattle, WA 98104-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7819HA | REGENCE BLUE SHIELD PIN (01) | WA |
7849HA | REGENCE BLUE SHIELD PIN (01) | WA |