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General NPI Number Information
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NPI Number | 1588271415
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Entity Type | Individual
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Provider Name | JEANNINE HANNUM OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 31 STAPLES ST
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City | DANBURY
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State | CT
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Zip | 06810-5323
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Country | US
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Telephone | 203-794-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 30 LAKESPRING DR
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City | BREWSTER
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State | NY
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Zip | 10509-5933
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Country | US
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Telephone | 914-715-2053
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 024123
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5295
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License Number State | CT
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