Provider Demographics
NPI:1326720012
Name:BANNAI-HALL, HANAKO VIVIAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:HANAKO
Middle Name:VIVIAN
Last Name:BANNAI-HALL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1246
Mailing Address - Country:US
Mailing Address - Phone:207-564-3463
Mailing Address - Fax:
Practice Address - Street 1:207 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1246
Practice Address - Country:US
Practice Address - Phone:207-564-3463
Practice Address - Fax:207-564-3900
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA4496224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOA4496OtherOCCUPATIONAL THERAPY ASSISTANT