Provider Demographics
NPI:1023226859
Name:HANSEN, KATHLEEN D (OTD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:HANSEN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:D
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6736 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9432
Mailing Address - Country:US
Mailing Address - Phone:267-625-3122
Mailing Address - Fax:
Practice Address - Street 1:6736 GRAY ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9432
Practice Address - Country:US
Practice Address - Phone:267-625-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2399225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist