Provider Demographics
NPI:1922202662
Name:HASSAN, IRIS E (COTA)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:E
Last Name:HASSAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 ALDER ST
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3155
Mailing Address - Country:US
Mailing Address - Phone:219-397-1080
Mailing Address - Fax:219-397-1080
Practice Address - Street 1:4325 ALDER ST
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3155
Practice Address - Country:US
Practice Address - Phone:219-397-1080
Practice Address - Fax:219-397-1080
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001401A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant