Provider Demographics
NPI:1083964886
Name:HANNAN, KATHRYN ERIN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ERIN
Last Name:HANNAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HOGBACK RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9736
Mailing Address - Country:US
Mailing Address - Phone:734-332-3800
Mailing Address - Fax:734-707-0606
Practice Address - Street 1:2002 HOGBACK RD
Practice Address - Street 2:SUITE 14
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9736
Practice Address - Country:US
Practice Address - Phone:734-332-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001542225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist