Basic Information
| Provider Information | |||||||||
| NPI: | 1124441902 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONKEL | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2656 LONGWOOD DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454311620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375723618 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1694 PAWNEE DR | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453854126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373725210 | ||||||||
| FaxNumber: | 9373725250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | 05123 | OH | Y | Other Service Providers | Contractor |
No ID Information.