Provider Demographics
NPI:1700417508
Name:HANEY, PATRICK PAUL (OT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:PAUL
Last Name:HANEY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:PAUL
Other - Last Name:HANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:218 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-2130
Mailing Address - Country:US
Mailing Address - Phone:740-852-3100
Mailing Address - Fax:
Practice Address - Street 1:218 ELM ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-2130
Practice Address - Country:US
Practice Address - Phone:740-852-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA