Provider Demographics
NPI:1073395034
Name:RISSE, HANNA JO (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:HANNA
Middle Name:JO
Last Name:RISSE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2614
Mailing Address - Country:US
Mailing Address - Phone:319-415-4628
Mailing Address - Fax:
Practice Address - Street 1:6901 PECKHAM ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-3143
Practice Address - Country:US
Practice Address - Phone:515-253-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123085225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty