MEDICARE: KIMBERLEE FAITH HANSON OTR/L, CHT

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	:	1265517775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEE FAITH HANSON OTR/L, CHT

Provider Business Mailing Address
First Line	:	PO BOX 29870
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9870
Country	:	US
Telephone Number	:	602-772-3800
Fax Number	:	602-772-3801

Provider Business Practice Location Address
First Line	:	1760 E PECOS RD STE 207
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-3202
Country	:	US
Telephone Number	:	480-964-2908
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/05/2017

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