Provider Demographics
NPI:1487036919
Name:KLEIN-HANSEN, THERESA (LMT, CPMT, MLD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KLEIN-HANSEN
Suffix:
Gender:F
Credentials:LMT, CPMT, MLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 DILL AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5518
Mailing Address - Country:US
Mailing Address - Phone:419-626-0381
Mailing Address - Fax:
Practice Address - Street 1:269 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2500
Practice Address - Country:US
Practice Address - Phone:419-357-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-20
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist