Provider Demographics
NPI:1841076874
Name:O'HANLON, DEANNA (MT)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:O'HANLON
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 1:5 BARTEL DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2201
Mailing Address - Country:US
Mailing Address - Phone:631-923-7420
Mailing Address - Fax:
Practice Address - Street 1:208 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3445
Practice Address - Country:US
Practice Address - Phone:631-462-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist