Provider Demographics
NPI:1164930426
Name:HATFIELD, PAIGE MARIE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:MARIE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N WOOD ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1083
Mailing Address - Country:US
Mailing Address - Phone:217-690-5378
Mailing Address - Fax:
Practice Address - Street 1:229 E PINE ST
Practice Address - Street 2:
Practice Address - City:MOWEAQUA
Practice Address - State:IL
Practice Address - Zip Code:62550-1041
Practice Address - Country:US
Practice Address - Phone:217-768-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0042952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer