Provider Demographics
NPI:1013953967
Name:HANNON, SUE A (MS, ATC, CSCS, PES)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:A
Last Name:HANNON
Suffix:
Gender:F
Credentials:MS, ATC, CSCS, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2023
Mailing Address - Country:US
Mailing Address - Phone:716-372-9591
Mailing Address - Fax:
Practice Address - Street 1:144 N 15TH ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2023
Practice Address - Country:US
Practice Address - Phone:716-372-9591
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000022-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer