Provider Demographics
NPI:1801815337
Name:HANSON, PENELOPE J (OTR)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:J
Last Name:HANSON
Suffix:
Gender:F
Credentials:OTR
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 2020
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0274
Mailing Address - Country:US
Mailing Address - Phone:307-857-7074
Mailing Address - Fax:307-857-1072
Practice Address - Street 1:911 FLAG DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2312
Practice Address - Country:US
Practice Address - Phone:307-857-7074
Practice Address - Fax:307-857-1072
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR - 307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20663Medicare ID - Type Unspecified