Provider Demographics
NPI:1740854413
Name:HATMAKER, TAYLOR SCOTT REI
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SCOTT REI
Last Name:HATMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 RUMFORD PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5677
Mailing Address - Country:US
Mailing Address - Phone:865-712-1730
Mailing Address - Fax:
Practice Address - Street 1:210 FOXHALL RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-6790
Practice Address - Country:US
Practice Address - Phone:252-223-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13952225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist