Basic Information
| Provider Information | |||||||||
| NPI: | 1184634578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HABERMAN | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | BOX 359750 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067449888 | ||||||||
| FaxNumber: | 2067449773 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | BOX 359920 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067313000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT00001678 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | OT00001678 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 7849HA | 01 | WA | REGENCE BLUE SHIELD PIN | OTHER | 7819HA | 01 | WA | REGENCE BLUE SHIELD PIN | OTHER |