Healthcare Provider Details

I. General information

NPI: 1124274865
Provider Name (Legal Business Name): CAROLYN HANSEN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CASSON HILL RD.
FORT RILEY KS
66442
US

IV. Provider business mailing address

600 CASSON HILL RD.
FORT RILEY KS
66442
US

V. Phone/Fax

Practice location:
  • Phone: 785-839-7863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: