MEDICARE: ELISA BETH MICHAUD-HANSON PA, OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA02165	TX
2	225XP0200X	Pediatric Occupational Therapist	115114	TX
3	225XN1300X	Neurorehabilitation Occupational Therapist	115114	TX
4	225XH1300X	Human Factors Occupational Therapist	115114	TX

General Provider Information

NPI Number	:	1336301357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA BETH MICHAUD-HANSON PA, OT

Provider Business Mailing Address
First Line	:	11107 HOMRIGHAUS RD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77554-9479
Country	:	US
Telephone Number	:	281-788-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WEST LOOP S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	281-788-6661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	05/01/2013

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