Provider Demographics
NPI:1619273166
Name:HATHAWAY, CARRIE M (OTR)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:M
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:M
Other - Last Name:MARCHENKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 N AURORA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4202
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:322 N AURORA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4202
Practice Address - Country:US
Practice Address - Phone:607-257-5858
Practice Address - Fax:607-257-1718
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist