Provider Demographics
NPI:1407258734
Name:HANNA, JESSICA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:20 PEACHTREE CT
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2535
Mailing Address - Country:US
Mailing Address - Phone:631-428-2445
Mailing Address - Fax:
Practice Address - Street 1:23 LAUREL LN
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2562
Practice Address - Country:US
Practice Address - Phone:631-428-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist