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General NPI Number Information
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NPI Number | 1033398300
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Entity Type | Individual
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Provider Name | HEATH HANSEN
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Gender | Male
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 11/23/2007
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Provider Practice Location Address
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Address Line | 9009B INDIANAPOLIS BLVD
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City | HIGHLAND
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State | IN
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Zip | 46322-2502
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Country | US
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Telephone | 219-923-0454
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Fax |
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Provider Business Mailing Address
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Address Line | 12400 S HARLEM AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1440
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number |
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State | IN
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