Provider Demographics
NPI:1942879275
Name:HANNABASS, NATALIE L
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:L
Last Name:HANNABASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 POLARIS PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7989
Mailing Address - Country:US
Mailing Address - Phone:614-776-0970
Mailing Address - Fax:
Practice Address - Street 1:300 POLARIS PKWY STE 160
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7989
Practice Address - Country:US
Practice Address - Phone:614-776-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19774225X00000X
OHOT011856225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist