Provider Demographics
NPI:1285985739
Name:HANSON, SHANAE LEIGHANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:SHANAE
Middle Name:LEIGHANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:SHANAE
Other - Middle Name:LEIGHANN
Other - Last Name:ABDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 41
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:716-474-6200
Mailing Address - Fax:
Practice Address - Street 1:420 GAFFNEY DRIVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-836-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4644225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist