Provider Demographics
NPI:1609106665
Name:HANSEN, FREDRIK A (OT)
Entity Type:Individual
Prefix:
First Name:FREDRIK
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 LORANCE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-9054
Mailing Address - Country:US
Mailing Address - Phone:870-535-0010
Mailing Address - Fax:870-535-1116
Practice Address - Street 1:2612 LORANCE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-9054
Practice Address - Country:US
Practice Address - Phone:870-535-0010
Practice Address - Fax:870-535-1116
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist