Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 11250 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2251 | NH |
NPI | 1003127705 |
---|---|
Provider Name | Ms. Amanda Rose Hansell |
First Address | Eliot, ME 03903-2292 |
Second Address | Manchester, NH 03103-4803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 18/09/2012 |