Provider Demographics
NPI:1891130654
Name:HATCH, WHITLEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:WHITLEY
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-3075
Mailing Address - Country:US
Mailing Address - Phone:706-624-3000
Mailing Address - Fax:706-624-3001
Practice Address - Street 1:14A PROFESSIONAL CT SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2832
Practice Address - Country:US
Practice Address - Phone:706-624-3000
Practice Address - Fax:706-624-3001
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005669225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133712AMedicaid