MEDICARE: SANDRA OCASIO HANSSON

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	056.002661	IL

General Provider Information

NPI Number	:	1164164562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA OCASIO HANSSON

Provider Business Mailing Address
First Line	:	3742 N NORDICA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2323
Country	:	US
Telephone Number	:	773-732-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	3742 N NORDICA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2323
Country	:	US
Telephone Number	:	773-732-6610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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Directions to “ SANDRA OCASIO HANSSON ” Practice Location

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