Provider Demographics
NPI:1508133984
Name:HANELL, HEATHER JILL
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JILL
Last Name:HANELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5585
Mailing Address - Country:US
Mailing Address - Phone:309-269-3761
Mailing Address - Fax:
Practice Address - Street 1:4343 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4203
Practice Address - Country:US
Practice Address - Phone:309-796-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist