Provider Demographics
NPI:1134302003
Name:HATLEY, AMANDA GENRY
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GENRY
Last Name:HATLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 280; BUSINESS TOWER 1, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:843-509-2443
Mailing Address - Fax:
Practice Address - Street 1:17480 N DALLAS PKWY
Practice Address - Street 2:STE 221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287
Practice Address - Country:US
Practice Address - Phone:214-623-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111943225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics