Provider Demographics
NPI:1023783941
Name:HINES, HANNAH DAWNELL (OTA/L)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:DAWNELL
Last Name:HINES
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11546 W SCOTTS DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3900
Mailing Address - Country:US
Mailing Address - Phone:308-383-0550
Mailing Address - Fax:
Practice Address - Street 1:9940 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1673
Practice Address - Country:US
Practice Address - Phone:623-933-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant