Provider Demographics
NPI:1053947770
Name:HAAK, RACHEL NICOLE (COTA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:HAAK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18427 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3310
Mailing Address - Country:US
Mailing Address - Phone:708-264-0262
Mailing Address - Fax:
Practice Address - Street 1:1500 N CLYBOURN AVE UNIT C105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2295
Practice Address - Country:US
Practice Address - Phone:312-242-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005346225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics