1679897276 NPI number — KRISTI MAE HANSON OCCUPATIONAL THERAPY

Table of content: KRISTI MAE HANSON OCCUPATIONAL THERAPY (NPI 1679897276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679897276 NPI number — KRISTI MAE HANSON OCCUPATIONAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
KRISTI
Provider Middle Name:
MAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMMER
Provider Other First Name:
KRISTI
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OCCUPATIONAL THERAPY
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679897276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 LONDON RD STE 102
Provider Second Line Business Mailing Address:
ESSENTIA HEALTH LAKEWALK CLINIC
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55812-1787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-576-0100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 LONDON RD STE 102
Provider Second Line Business Practice Location Address:
ESSENTIA HEALTH LAKEWALK CLINIC
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55812-1787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-576-0100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2010

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:  100852 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1679897276 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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