Provider Demographics
NPI:1992344667
Name:HASAN, SUGHRA (OT)
Entity type:Individual
Prefix:
First Name:SUGHRA
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74008660
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8660
Mailing Address - Country:US
Mailing Address - Phone:410-970-8180
Mailing Address - Fax:
Practice Address - Street 1:7500 GREENWAY CENTER DR STE 111
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-513-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08858224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant