Provider Demographics
NPI:1730705542
Name:BURKS, HANNAH ALYSSA (MOT/L)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ALYSSA
Last Name:BURKS
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4543
Mailing Address - Country:US
Mailing Address - Phone:307-258-7622
Mailing Address - Fax:
Practice Address - Street 1:2020 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4007
Practice Address - Country:US
Practice Address - Phone:307-235-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1499LL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist