Basic Information
| Provider Information | |||||||||
| NPI: | 1790379055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASSON | ||||||||
| FirstName: | DEVIN | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | MA, LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 ALAN AVE SW | ||||||||
| Address2: | |||||||||
| City: | SWISHER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523389617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093680420 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 PRAIRIE MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522428001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193847070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2021 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.