Basic Information
| Provider Information | |||||||||
| NPI: | 1578533907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASKINS | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PHD, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6002 | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582066002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017805000 | ||||||||
| FaxNumber: | 7017801942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 SOUTH COLUMBIA ROAD | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582066002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017805000 | ||||||||
| FaxNumber: | 7017801942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 10/19/2009 | ||||||||
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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 | 102340 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 709 | ND | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | #709 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225XH1200X | #102340 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 2379849 | 01 | UNITED HEALTH CARE | OTHER | 694G3HA | 01 | MN | BCBS | OTHER | 700A8AX | 01 | MN | BCBS | OTHER | 25944 | 01 | ND | BCBS | OTHER | 1042277 | 01 | PREFERRED ONE | OTHER | 50899 | 05 | ND | MEDICAID | 64-05826 | 01 | MEDICA | OTHER | 747655800 | 01 | MN | MEDICAL ASSISTANCE | OTHER | HP40228 | 01 | HEALTH PARTNERS | OTHER | 25944 | 01 | NORIDIAN MUTUAL | OTHER | 967323700 | 01 | MN | MEDICAL ASSISTANCE | OTHER |