Provider Demographics
NPI:1417158502
Name:HANSON, ROBERT JOHN (OT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:HANSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HOMESTEAD CIR
Mailing Address - Street 2:
Mailing Address - City:S HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1410
Mailing Address - Country:US
Mailing Address - Phone:781-979-3188
Mailing Address - Fax:781-979-3189
Practice Address - Street 1:36 HOMESTEAD CIR
Practice Address - Street 2:
Practice Address - City:S HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-1410
Practice Address - Country:US
Practice Address - Phone:781-979-3188
Practice Address - Fax:781-979-3189
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist