Provider Demographics
NPI:1255455606
Name:HATTER, ANNETTE MARIE (OTRL)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:HATTER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2263
Mailing Address - Country:US
Mailing Address - Phone:630-582-4263
Mailing Address - Fax:
Practice Address - Street 1:2176 GLADSTONE CT
Practice Address - Street 2:SUITES A/B
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1600
Practice Address - Country:US
Practice Address - Phone:630-715-0095
Practice Address - Fax:630-582-4263
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002227225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist