Healthcare Provider Details

I. General information

NPI: 1609417419
Provider Name (Legal Business Name): HANNAH BURNS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAURENCE AVE STE E
JACKSON MI
49202-2980
US

IV. Provider business mailing address

1023 CRANBROOK RD
JACKSON MI
49201-8143
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-4777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010695
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201010695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: