Provider Demographics
NPI:1174260723
Name:HATCH, CRYSTAL (COTA/L)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3164
Mailing Address - Country:US
Mailing Address - Phone:385-646-5000
Mailing Address - Fax:
Practice Address - Street 1:415 E SILVER LEAF DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-2609
Practice Address - Country:US
Practice Address - Phone:801-458-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty