Provider Demographics
NPI:1508172883
Name:HARDEMAN, LANA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:HARDEMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 COLUMBIA ROAD,
Mailing Address - Street 2:12-A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-863-7694
Mailing Address - Fax:706-863-1607
Practice Address - Street 1:4210 COLUMBIA RD
Practice Address - Street 2:12-A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0401
Practice Address - Country:US
Practice Address - Phone:706-863-7694
Practice Address - Fax:706-863-1607
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist