Individual
JOHN HANCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2125 ROYCE ST, PORTSMOUTH, OH 45662-4714
(740) 354-6635
Mailing address
1611 KINNEYS LN, PORTSMOUTH, OH 45662-3115
(740) 464-9885
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT007742
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT007742
OHIO OTPTAT BOARD
OH
Enumeration date
08/29/2018
Last updated
08/29/2018
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