Provider Demographics
NPI:1861903437
Name:HAAN, ALYSSA EMILY (OTR)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:EMILY
Last Name:HAAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:E
Other - Last Name:MACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-1510
Mailing Address - Country:US
Mailing Address - Phone:715-838-3635
Mailing Address - Fax:
Practice Address - Street 1:13025 8TH ST
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758
Practice Address - Country:US
Practice Address - Phone:715-597-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6066-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist