MEDICARE: NEAL HAKANSON, OT, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1033301585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEAL HAKANSON, OT, PC

Provider Business Mailing Address
First Line	:	7119 SHORE RD
Second Line	:	4D
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1860
Country	:	US
Telephone Number	:	718-768-7501
Fax Number	:	718-768-7502

Provider Business Practice Location Address
First Line	:	360A 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4008
Country	:	US
Telephone Number	:	718-768-7501
Fax Number	:	718-768-7502

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NEAL HAKANSON
Credential	:	OT
Telephone Number	:	718-768-7501

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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