Provider Demographics
NPI:1346013455
Name:HANSON, MARY KATHLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:HANSON
Suffix:
Gender:F
Credentials: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:SCHOOL ADMINISTRATION UNIT 13 881 TAMWORTH RD #A
Mailing Address - Street 2:881 TAMWORTH RD #A
Mailing Address - City:TAMWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03886
Mailing Address - Country:US
Mailing Address - Phone:603-323-5088
Mailing Address - Fax:
Practice Address - Street 1:SAU 13
Practice Address - Street 2:881 TAMWORTH RD #A
Practice Address - City:TAMWORTH
Practice Address - State:NH
Practice Address - Zip Code:03886
Practice Address - Country:US
Practice Address - Phone:603-323-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH225X00000X
NH1214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist