Provider Demographics
NPI:1497983282
Name:HANSON, EMILY ANN (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 BROADWAY ST N
Mailing Address - Street 2:SUITE 113
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1421 BROADWAY ST N
Practice Address - Street 2:SUITE 113
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-4728
Practice Address - Country:US
Practice Address - Phone:715-544-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4801-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist