Healthcare Provider Details

I. General information

NPI: 1144032921
Provider Name (Legal Business Name): HANNAH CRISP OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E LOOP 281 STE B1
LONGVIEW TX
75605-7969
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 903-757-7731
  • Fax:
Mailing address:
  • Phone: 856-678-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number124246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: