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
State | License ID | Taxonomies |
---|---|---|
NY | 015313-1 | 225X00000X, 225XE1200X, 225XL0004X, 225XN1300X, 225XP0200X, 225XR0403X |
NY | 051313-1 | 225XE0001X |
AK | OT1085 | 225XP0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AK | OT1849 | Medicaid |