Provider Demographics
NPI:1841559119
Name:HAMANN, SUSAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HAMANN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6754 BIRDSONG WAY
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039
Mailing Address - Country:US
Mailing Address - Phone:513-373-0117
Mailing Address - Fax:
Practice Address - Street 1:8650 GOVERNORS HILL
Practice Address - Street 2:180
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:513-791-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02494251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02494Medicaid