Provider Demographics
NPI:1639545452
Name:RAFTERY, HANA
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:
Last Name:RAFTERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1351
Mailing Address - Country:US
Mailing Address - Phone:650-814-3468
Mailing Address - Fax:
Practice Address - Street 1:1885 LUNDY AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1887
Practice Address - Country:US
Practice Address - Phone:650-814-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program