Provider Demographics
NPI:1316187693
Name:HATTON, AMANDA SUSAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUSAN
Last Name:HATTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 HEATHERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5814
Mailing Address - Country:US
Mailing Address - Phone:614-219-7019
Mailing Address - Fax:
Practice Address - Street 1:3804 FISHINGER BLVD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9551
Practice Address - Country:US
Practice Address - Phone:614-777-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15728225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist