Provider Demographics
NPI:1679078448
Name:MATTOCKS, HANNAH RAE (RN, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:RAE
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:RN, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 GALLERIA CLUB LN APT 213
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2538
Mailing Address - Country:US
Mailing Address - Phone:828-550-1725
Mailing Address - Fax:
Practice Address - Street 1:1718 GALLERIA CLUB LN APT 213
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2538
Practice Address - Country:US
Practice Address - Phone:828-550-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-35812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty