Provider Demographics
NPI:1982467114
Name:HANNER, CHELSEY RAE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:RAE
Last Name:HANNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:RAE
Other - Last Name:TOMSICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:368 CHRISTY RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081-9732
Mailing Address - Country:US
Mailing Address - Phone:716-640-6783
Mailing Address - Fax:
Practice Address - Street 1:103 CANADA ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9806
Practice Address - Country:US
Practice Address - Phone:716-537-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011351-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant