Provider Demographics
NPI:1124228606
Name:HANSON, KATHLEEN GAIL (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GAIL
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 S BRIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4018
Mailing Address - Country:US
Mailing Address - Phone:480-634-1676
Mailing Address - Fax:
Practice Address - Street 1:1833 S BRIGHTON CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4018
Practice Address - Country:US
Practice Address - Phone:480-634-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ228603OtherAHCCCS