Provider Demographics
NPI:1073955399
Name:HATCH, TINA MARIA (OTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIA
Last Name:HATCH
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:58 PHYSICIANS DR
Mailing Address - Street 2:STE #106
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4215
Mailing Address - Country:US
Mailing Address - Phone:910-755-5437
Mailing Address - Fax:910-755-6076
Practice Address - Street 1:58 PHYSICIANS DR
Practice Address - Street 2:STE #106
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4215
Practice Address - Country:US
Practice Address - Phone:910-755-5437
Practice Address - Fax:910-755-6076
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5526224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant