1124353347 NPI number — DIANE JUNE HABEGGER O.T.R.

Table of content: DIANE JUNE HABEGGER O.T.R. (NPI 1124353347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124353347 NPI number — DIANE JUNE HABEGGER O.T.R.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABEGGER
Provider First Name:
DIANE
Provider Middle Name:
JUNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T.R.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AHO
Provider Other First Name:
DIANE
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.R.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124353347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49017-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-788-3040
Provider Business Mailing Address Fax Number:
269-788-3043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017-3258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-788-3040
Provider Business Practice Location Address Fax Number:
269-788-3043
Provider Enumeration Date:
10/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  5201003053 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)