Provider Demographics
NPI:1326829235
Name:HATFIELD, MEGHAN DIANE (COTA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:DIANE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13219 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865-8223
Mailing Address - Country:US
Mailing Address - Phone:417-499-9750
Mailing Address - Fax:
Practice Address - Street 1:3222 JOHN DUFFY DR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1569
Practice Address - Country:US
Practice Address - Phone:417-621-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023010266224Z00000X
OK2554224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant