Provider Demographics
NPI:1407576671
Name:MIDDLETON, HANNAH GENE (OTA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GENE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:GENE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:7625 OLD PACIFIC HWY N
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-9626
Mailing Address - Country:US
Mailing Address - Phone:360-669-9967
Mailing Address - Fax:
Practice Address - Street 1:179 DIECKMAN RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-9614
Practice Address - Country:US
Practice Address - Phone:360-748-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60923823224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant