Provider Demographics
NPI:1619039369
Name:HANS, SUSAN (OTRL)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:HANS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24941 AMERICA CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-8335
Mailing Address - Country:US
Mailing Address - Phone:701-367-4736
Mailing Address - Fax:
Practice Address - Street 1:24941 AMERICA CENTER RD
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-8335
Practice Address - Country:US
Practice Address - Phone:701-367-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0750225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDLAN22704OtherBCBS ND PROVIDER NUMBER
ND2239246OtherFIRST HEALTH
MNHP75679OtherHEALTHPARTNERS
NDB17351047567OtherPREFERREDONE PIN NUMBER
MN385492000OtherMHCP
ND54430Medicaid
ND64-04763OtherMEDICA PROVIDER NUMBER