Provider Demographics
NPI:1659447910
Name:HANSEN, LOREYN LEIGH (OTR)
Entity type:Individual
Prefix:
First Name:LOREYN
Middle Name:LEIGH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 YALE STATION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-9249
Mailing Address - Country:US
Mailing Address - Phone:315-585-6060
Mailing Address - Fax:
Practice Address - Street 1:422 CLINTON AVE S
Practice Address - Street 2:ABVI- GOODWILL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1103
Practice Address - Country:US
Practice Address - Phone:585-327-5598
Practice Address - Fax:585-232-2972
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015313-1225X00000X, 225XE1200X, 225XL0004X, 225XN1300X, 225XP0200X, 225XR0403X
NY051313-1225XE0001X
AKOT1085225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT1849Medicaid