Provider Demographics
NPI:1588108872
Name:HAUN, LAURA (ATC)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:HAUN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MCGINNIS DR
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1262
Mailing Address - Country:US
Mailing Address - Phone:208-550-7003
Mailing Address - Fax:
Practice Address - Street 1:275 MCGINNIS DR
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-1262
Practice Address - Country:US
Practice Address - Phone:208-550-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer