Provider Demographics
NPI:1871956607
Name:KOELBL, HANNAH LAMAR (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LAMAR
Last Name:KOELBL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 60TH LN
Mailing Address - Street 2:APT 3
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3578
Mailing Address - Country:US
Mailing Address - Phone:865-621-2973
Mailing Address - Fax:
Practice Address - Street 1:6063 60TH LN
Practice Address - Street 2:APT 3
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3578
Practice Address - Country:US
Practice Address - Phone:865-621-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist