Individual
KIRAN C HANSBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11512 LAKE MEAD AVE UNIT 604, JACKSONVILLE, FL 32256-9686
(904) 652-5408
Mailing address
5119 CRYSTAL PARK LN, ELLICOTT CITY, MD 21043-7947
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
07798
MD
225X00000X
Occupational Therapist
Primary
OT20423
FL
Other
Enumeration date
05/13/2016
Last updated
09/04/2020
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