Provider Demographics
NPI:1407585136
Name:HANN, AJA (OT)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:HANN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AJA RACHEL
Other - Middle Name:
Other - Last Name:HANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2681 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6375
Mailing Address - Country:US
Mailing Address - Phone:442-400-0178
Mailing Address - Fax:
Practice Address - Street 1:2681 BROAD ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6375
Practice Address - Country:US
Practice Address - Phone:442-400-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist