Provider Demographics
NPI:1487807426
Name:HASKELL, MARY-ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARY-ANN
Middle Name:
Last Name:HASKELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-0330
Mailing Address - Country:US
Mailing Address - Phone:845-339-2215
Mailing Address - Fax:845-339-2215
Practice Address - Street 1:715 STONE LN
Practice Address - Street 2:
Practice Address - City:WEST HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12491-5019
Practice Address - Country:US
Practice Address - Phone:845-339-2215
Practice Address - Fax:845-339-2215
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007548-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist