Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 014499 | NY |
N | 225X00000X | Occupational Therapist | OT46TR00560200 | NJ |
N | 225X00000X | Occupational Therapist | OT46TR00560209 | NJ |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT46TR00560200 |
NPI | 1033327408 |
---|---|
Provider Name | Ms. Kristin L Ryan-Hannaway |
First Address | Freehold, NJ 07728-8878 |
Second Address | Eatontown, NJ 07724-3903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 16/10/2019 |