Provider Demographics
NPI:1679897276
Name:HANSON, KRISTI MAE (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MAE
Last Name:HANSON
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:MAE
Other - Last Name:HAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCCUPATIONAL THERAPY
Mailing Address - Street 1:1502 LONDON RD STE 102
Mailing Address - Street 2:ESSENTIA HEALTH LAKEWALK CLINIC
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1787
Mailing Address - Country:US
Mailing Address - Phone:218-576-0100
Mailing Address - Fax:
Practice Address - Street 1:1502 LONDON RD STE 102
Practice Address - Street 2:ESSENTIA HEALTH LAKEWALK CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1787
Practice Address - Country:US
Practice Address - Phone:218-576-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100852225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679897276Medicaid