Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | AZ |
NPI | 1023783941 |
---|---|
Provider Name | Hannah Dawnell Hines |
First Address | El Mirage, AZ 85335-3900 |
Second Address | Sun City, AZ 85373-1673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2021 |
Last Update Date | 12/08/2021 |