Provider Demographics
NPI:1487796983
Name:HANNER, NADINE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:
Last Name:HANNER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9323
Mailing Address - Country:US
Mailing Address - Phone:843-851-3689
Mailing Address - Fax:843-851-3689
Practice Address - Street 1:1797 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-9323
Practice Address - Country:US
Practice Address - Phone:843-851-3689
Practice Address - Fax:843-851-3689
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1603Medicaid