Basic Information
| Provider Information | |||||||||
| NPI: | 1619631371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | MCKAYLA | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 S WILLOW ST STE 128 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031035723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 MAIN ST S | ||||||||
| Address2: | |||||||||
| City: | VELVA | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587907342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013382072 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2021 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1891 | ND | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.