Active NPI
Bruce Allan Haack, OTD
- Occupational Therapist
- Vancouver, WA
National Provider Identifier
1285088179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT00002138
- Practice address
- 13604 NE 42ND Ave
Vancouver, WA 98686-2606 - Phone
- (360) 931-1152
- Fax
- (360) 397-6823
- NPI assigned
- Apr 18, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT00002138 | WA | Primary |
Addresses
Primary practice location
13604 NE 42ND Ave
Vancouver, WA 98686-2606
Mailing address
13604 NE 42ND Ave
Vancouver, WA 98686-2606
Phone (360) 931-1152
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT00002138 | WA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460937600000",
"number": "1285088179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13604 NE 42ND AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986862606",
"telephone_number": "360-931-1152",
"fax_number": "360-397-6823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13604 NE 42ND AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986862606",
"telephone_number": "360-931-1152",
"fax_number": "360-397-6823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAACK",
"first_name": "BRUCE",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "OTD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-18",
"last_updated": "2016-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "OT00002138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
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- Linda Christine Gwinn, MN, RN, CNS, CCRN
- H & Y Medical Supplies, LLC
- H&S Northwest LLC (Hand & Stone Massage and Facial Spa)
- Allen Ha, PHARM D
- Lisa Marie Haacker, PHARMACY TECHNIEIAN
- Hugh B Haagen, MSW
- Taylor Denton Lewis Haak, DC
- Michelle Ann Haase
- Joseph Jeffrey Haberman, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.