Provider Demographics
NPI:1265631279
Name:HATCHETT, ROSE A (MA, OTR, LPC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:HATCHETT
Suffix:
Gender:F
Credentials:MA, OTR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8266 CLINTON MACON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236-9532
Mailing Address - Country:US
Mailing Address - Phone:517-423-1915
Mailing Address - Fax:
Practice Address - Street 1:8266 CLINTON MACON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236-9532
Practice Address - Country:US
Practice Address - Phone:517-423-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL705804225XN1300X
MI2674691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD600040OtherBCBS
MI670D610640Medicare PIN