Provider Demographics
NPI:1205941317
Name:HATTON, KATHY (COTA/L)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:HATTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 897
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-9027
Mailing Address - Country:US
Mailing Address - Phone:618-895-4260
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 897
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9027
Practice Address - Country:US
Practice Address - Phone:618-895-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL57002446224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8030288OtherBLUECROSS/BLUESHIELD IL