Provider Demographics
NPI:1811733264
Name:HANSON, RILEY DANA-MARIE
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:DANA-MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 BATTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:ME
Mailing Address - Zip Code:04927-3733
Mailing Address - Country:US
Mailing Address - Phone:207-907-8443
Mailing Address - Fax:
Practice Address - Street 1:19 WHITE PINE RD STE C
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0258
Practice Address - Country:US
Practice Address - Phone:207-355-1550
Practice Address - Fax:207-480-1541
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4675225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist