Provider Demographics
NPI:1528558681
Name:PUGH, HANNAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:PUGH
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 1:2112 N SEMINARY AVE APT 21
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4141
Mailing Address - Country:US
Mailing Address - Phone:586-709-3095
Mailing Address - Fax:
Practice Address - Street 1:41 FLATBUSH AVE STE 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1145
Practice Address - Country:US
Practice Address - Phone:773-523-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012272225X00000X
NY025951225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL510217097Medicaid