Basic Information
Provider Information
NPI: 1851537336
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HESSABI
FirstName: NAZANIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2222 SULLIVAN TRL
Address2:  
City: EASTON
State: PA
PostalCode: 180407958
CountryCode: US
TelephoneNumber: 8009449782
FaxNumber: 6104382024
Practice Location
Address1: 445 N WESTVIEW DR
Address2:  
City: DERBY
State: KS
PostalCode: 670372228
CountryCode: US
TelephoneNumber: 3167884547
FaxNumber: 3167888858
Other Information
ProviderEnumerationDate: 01/05/2009
LastUpdateDate: 01/05/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X1701441KSY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home