Provider Demographics
NPI:1306211636
Name:HATI, MOUMITA
Entity Type:Individual
Prefix:
First Name:MOUMITA
Middle Name:
Last Name:HATI
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 1:1101 BEAUMONT CENTRE LN
Mailing Address - Street 2:APARTMENT 8206
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1758
Mailing Address - Country:US
Mailing Address - Phone:201-744-4761
Mailing Address - Fax:
Practice Address - Street 1:1101 BEAUMONT CENTRE LN
Practice Address - Street 2:APARTMENT 8206
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1758
Practice Address - Country:US
Practice Address - Phone:201-744-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLPLPA00223722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist