Individual
GRANT J HASENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 477-1558
(812) 474-2296
Mailing address
7300 E INDIANA ST, SUITE 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005321A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000778985
BLUE CROSS BLUE SHIELD
IN
01
—
000000779303
BLUE CROSS BLUE SHIELD
IN
01
—
000000779590
BLUE CROSS BLUE SHIELD
IN
05
—
201121040
—
IN
Enumeration date
07/09/2012
Last updated
02/13/2013
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