Provider Demographics
NPI:1467702183
Name:HANSEN, MITCHEL BAIRD
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:BAIRD
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 KENT ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2317
Mailing Address - Country:US
Mailing Address - Phone:315-797-2233
Mailing Address - Fax:315-797-2244
Practice Address - Street 1:507 KENT ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2317
Practice Address - Country:US
Practice Address - Phone:315-797-2233
Practice Address - Fax:315-797-2244
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind