Provider Demographics
NPI:1295296077
Name:HALLISSEY, HANNAH M (MS, ATC)
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:M
Last Name:HALLISSEY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WINDWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2155
Mailing Address - Country:US
Mailing Address - Phone:860-917-8693
Mailing Address - Fax:
Practice Address - Street 1:800 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3240
Practice Address - Country:US
Practice Address - Phone:203-596-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer