Individual
JESSE KAILYN HAEFNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
9000 W SURA LN, GREENFIELD, WI 53228-3477
(414) 246-6800
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7175-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100195260
—
WI
Enumeration date
02/10/2022
Last updated
01/26/2023
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