=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558679019
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARJORY HANSEN OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2010
-----------------------------------------------------
Last Update Date | 09/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 S LIVINGSTON AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-3017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-535-5010
-----------------------------------------------------
Fax | 973-535-8616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 WHISPERING PINE WAY
-----------------------------------------------------
City | OAK RIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07438-8885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-208-2664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 46TR00057300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------