1083203772 NPI number — HANNAH GARDNER OTR

Table of content: HANNAH GARDNER OTR (NPI 1083203772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083203772 NPI number — HANNAH GARDNER OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
HANNAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083203772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 CARLISLE ST APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GETTYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17325-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
171-735-7773
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2990 CARLISLE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW OXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17350-9582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-624-2161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2021

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:  OC017131 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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