Provider Demographics
NPI:1497343446
Name:KANTHAK, HANNAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:KANTHAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:420 MACON ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1815
Mailing Address - Country:US
Mailing Address - Phone:920-841-0660
Mailing Address - Fax:
Practice Address - Street 1:309 MOUNT CARMEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-4223
Practice Address - Country:US
Practice Address - Phone:252-438-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist