Provider Demographics
NPI:1346068871
Name:VANDER HAAR, OLIVIA (OT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:VANDER HAAR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18150 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5699
Mailing Address - Country:US
Mailing Address - Phone:703-835-3157
Mailing Address - Fax:
Practice Address - Street 1:7686 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1717
Practice Address - Country:US
Practice Address - Phone:402-819-8477
Practice Address - Fax:855-670-1789
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist