Active NPI
Tracy Lynn Haakenson, OT
- Occupational Therapist
- Cary, NC
National Provider Identifier
1124181912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 15602
- Practice address
- 981 High House Rd Ste 100
Cary, NC 27513-3510 - Phone
- (919) 388-0111
- Fax
- (919) 388-8668
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 160 | AZ | |
| Occupational Therapist | 225X00000X | 15602 | NC | Primary |
Addresses
Primary practice location
981 High House Rd Ste 100
Cary, NC 27513-3510
Mailing address
1650 Lyndon Farm CT Ste 300
Louisville, KY 40223-5005
Phone (502) 882-9379
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 170647 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15602 | NC | MD | Professional Counselor |
| 160 | AZ | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fiesta Pediatric Therapy | Pediatrics | Past | Accepting new patients |
| Breakthrough Physical Therapy | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Morehead City, NC
- NPI 1083937692
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671494400000",
"number": "1124181912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 LYNDON FARM CT STE 300",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402235005",
"telephone_number": "502-882-9379",
"fax_number": "502-805-0526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "981 HIGH HOUSE RD STE 100",
"city": "CARY",
"state": "NC",
"postal_code": "275133510",
"telephone_number": "919-388-0111",
"fax_number": "919-388-8668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAAKENSON",
"first_name": "TRACY",
"middle_name": "LYNN",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2022-12-20",
"certification_date": "2022-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "AZ",
"license": "160",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "15602",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "170647",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.