Provider Demographics
NPI:1760603914
Name:CORDILL, HANNAH ROSE (OTRL)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:CORDILL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13140 FREEMANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3747
Mailing Address - Country:US
Mailing Address - Phone:314-401-5239
Mailing Address - Fax:
Practice Address - Street 1:13140 FREEMANVILLE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3747
Practice Address - Country:US
Practice Address - Phone:314-401-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
SC3257225XP0200X
GAOT007934225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist