Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 057005346 | IL |
NPI | 1053947770 |
---|---|
Provider Name | Rachel Nicole Haak |
First Address | Lansing, IL 60438-3310 |
Second Address | Chicago, IL 60610-2295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2020 |
Last Update Date | 13/03/2020 |