Provider Demographics
NPI:1740915875
Name:HANSCOM, MIRIAM (MT)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:HANSCOM
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3707
Mailing Address - Country:US
Mailing Address - Phone:603-327-5271
Mailing Address - Fax:
Practice Address - Street 1:6 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3707
Practice Address - Country:US
Practice Address - Phone:603-327-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3585225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist