Healthcare Provider Details

I. General information

NPI: 1982955381
Provider Name (Legal Business Name): MS. MARTA JEAN HANSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 LINCOLN WAY E
MASSILLON OH
44646-8624
US

IV. Provider business mailing address

3545 LINCOLN WAY E
MASSILLON OH
44646-8624
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-5674
  • Fax: 330-837-3052
Mailing address:
  • Phone: 330-837-5674
  • Fax: 330-837-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA00610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: