Provider Demographics
NPI:1487026514
Name:BUMGARNER, HANNAH (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BUMGARNER
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1323
Mailing Address - Country:US
Mailing Address - Phone:417-735-3715
Mailing Address - Fax:
Practice Address - Street 1:720 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1010
Practice Address - Country:US
Practice Address - Phone:417-735-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015031158225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics