Provider Demographics
NPI:1639342181
Name:HANAK, LINDA LONDON (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LONDON
Last Name:HANAK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:JOY
Other - Last Name:HANAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 2465
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-2465
Mailing Address - Country:US
Mailing Address - Phone:970-586-9633
Mailing Address - Fax:
Practice Address - Street 1:1481 HIGH VISTA DR
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8210
Practice Address - Country:US
Practice Address - Phone:970-586-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000061630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist