Individual
STACY L HANNEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
10573 N FRIAR DR APT A, HAYDEN, ID 83835-8507
(661) 373-1118
Mailing address
10573 N FRIAR DR APT A, HAYDEN, ID 83835-8507
(661) 373-1118
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
OT-1767
ID
Other
Enumeration date
05/03/2006
Last updated
11/22/2022
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