Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 2674691 | MI |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | L705804 | MI |
NPI | 1265631279 |
---|---|
Provider Name | Rose A Hatchett |
First Address | Clinton, MI 49236-9532 |
Second Address | Clinton, MI 49236-9532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 27/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OD600040 | BCBS (01) | MI |