Provider Demographics
NPI:1659040996
Name:HAZLETT, JOHN HUNTER (OTR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HUNTER
Last Name:HAZLETT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7934 PLAYMOR TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1708
Mailing Address - Country:US
Mailing Address - Phone:619-823-9699
Mailing Address - Fax:
Practice Address - Street 1:7934 PLAYMOR TER
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1708
Practice Address - Country:US
Practice Address - Phone:619-823-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist