Provider Demographics
NPI:1699396697
Name:HANNA, MINA R (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:R
Last Name:HANNA
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 41ST AVE APT 5U
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1442
Mailing Address - Country:US
Mailing Address - Phone:917-214-3532
Mailing Address - Fax:
Practice Address - Street 1:14445 41ST AVE APT 5U
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1442
Practice Address - Country:US
Practice Address - Phone:917-214-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008957-1225200000X
NY024540-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant