Provider Demographics
NPI:1952709222
Name:KELLISON, HANNAH (COTA/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:KELLISON
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 1:27405 STEER CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-7210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RR1 BOX 212
Practice Address - Street 2:SCHUYLER COUNTY NURSING HOME
Practice Address - City:QUEEN CITY
Practice Address - State:MO
Practice Address - Zip Code:63561
Practice Address - Country:US
Practice Address - Phone:660-766-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014009870224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant