Provider Demographics
NPI:1811241201
Name:HANSON, TINA M (COTA/L)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:HANSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14919 E MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:MICA
Mailing Address - State:WA
Mailing Address - Zip Code:99023-9616
Mailing Address - Country:US
Mailing Address - Phone:509-370-5260
Mailing Address - Fax:
Practice Address - Street 1:19307 E CATALDO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-9489
Practice Address - Country:US
Practice Address - Phone:509-228-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60217889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist