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General NPI Number Information
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NPI Number | 1689553869
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Entity Type | Individual
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Provider Name | HANNAH BANECK
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Gender |
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 901 MULBERRY ST
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City | LAKE MILLS
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State | WI
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Zip | 53551-1335
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Country | US
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Telephone | 920-648-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 224 CLARK ST
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City | WATERTOWN
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State | WI
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Zip | 53094-6918
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Country | US
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Telephone | 920-285-6806
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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 | 8995-26
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License Number State | WI
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