Provider Demographics
NPI:1619224714
Name:HATTON, MARCIA ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
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 1:606 SAINT THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-1808
Mailing Address - Country:US
Mailing Address - Phone:618-641-7363
Mailing Address - Fax:
Practice Address - Street 1:606 SAINT THOMAS LN
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-1808
Practice Address - Country:US
Practice Address - Phone:618-641-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020590224Z00000X
IL057.003626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL086146578Medicaid