Provider Demographics
NPI:1558146795
Name:HATCH, JACLYN M (LMT, CPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:HATCH
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COFRAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03276-1623
Mailing Address - Country:US
Mailing Address - Phone:352-220-1030
Mailing Address - Fax:
Practice Address - Street 1:1 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:PENACOOK
Practice Address - State:NH
Practice Address - Zip Code:03303-1402
Practice Address - Country:US
Practice Address - Phone:352-220-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27140122255A2300X
NH8245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer