Provider Demographics
NPI:1558750166
Name:HANSON, DEBORAH I (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HANSON
Suffix:I
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7680 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-9522
Mailing Address - Country:US
Mailing Address - Phone:231-740-2938
Mailing Address - Fax:
Practice Address - Street 1:1635 W SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-3544
Practice Address - Country:US
Practice Address - Phone:231-755-4404
Practice Address - Fax:231-755-7704
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist