Individual
BRANDON HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
900 S RAND RD, LAKE ZURICH, IL 60047-2450
(847) 726-1200
Mailing address
4820 INMANS WAY, RINGWOOD, IL 60072-9693
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
381847
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H52506492075
DRIVER'S LICENSE
IL
Enumeration date
05/25/2017
Last updated
05/25/2017
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