Provider Demographics
NPI:1134772726
Name:GALLANT, HANNAH MARGARET (COTA/L)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARGARET
Last Name:GALLANT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MARGARET
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 S MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6036
Mailing Address - Country:US
Mailing Address - Phone:864-608-3074
Mailing Address - Fax:
Practice Address - Street 1:4501 OLD SPARTANBURG RD STE 7
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4105
Practice Address - Country:US
Practice Address - Phone:864-292-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4827224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant