Provider Demographics
NPI:1740760198
Name:HATHAWAY, BROOKE ABRIANNA KATHLEEN
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ABRIANNA KATHLEEN
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2288
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-2288
Mailing Address - Country:US
Mailing Address - Phone:509-464-9253
Mailing Address - Fax:
Practice Address - Street 1:706 E C ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-6055
Practice Address - Country:US
Practice Address - Phone:509-464-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist