Provider Demographics
NPI:1083187991
Name:BAXLEY, HANNAH BROOKE
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:BROOKE
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 VERDAE BLVD UNIT 1137
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-7801
Mailing Address - Country:US
Mailing Address - Phone:704-641-8782
Mailing Address - Fax:
Practice Address - Street 1:10 FOUNTAINVIEW TER
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4060
Practice Address - Country:US
Practice Address - Phone:704-641-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist