Provider Demographics
NPI:1669093746
Name:AGBAN HANNA, HANAN HAKEEM (COTA/L)
Entity type:Individual
Prefix:
First Name:HANAN
Middle Name:HAKEEM
Last Name:AGBAN HANNA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 S WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-3403
Mailing Address - Country:US
Mailing Address - Phone:508-369-4153
Mailing Address - Fax:
Practice Address - Street 1:355 S WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-3403
Practice Address - Country:US
Practice Address - Phone:508-369-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4031224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty