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Individual

MS. SUSAN MARY HAEGELE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
2801 S WEBSTER AVE, GREEN BAY, WI 54301-2878
(920) 337-1122
Mailing address
2419 WATSON CIR, DEPERE, WI 54115
(920) 339-0974

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1281-026
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40684600
WI
Enumeration date
06/28/2007
Last updated
07/09/2007
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