Provider Demographics
NPI:1659623304
Name:HANNAH, SHERRY MAELENE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:MAELENE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:KINCAID
Mailing Address - State:WV
Mailing Address - Zip Code:25119-0299
Mailing Address - Country:US
Mailing Address - Phone:304-465-4325
Mailing Address - Fax:
Practice Address - Street 1:325 JONES AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2908
Practice Address - Country:US
Practice Address - Phone:304-465-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2008-2406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist