Provider Demographics
NPI:1770541872
Name:HATA, KATHY LAURIE (OTR/L, LMP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LAURIE
Last Name:HATA
Suffix:
Gender:F
Credentials:OTR/L, LMP
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:LAURIE
Other - Last Name:HATA-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 9246
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-0246
Mailing Address - Country:US
Mailing Address - Phone:509-469-4996
Mailing Address - Fax:509-469-4922
Practice Address - Street 1:307 SOUTH 12TH AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-469-4996
Practice Address - Fax:509-469-4922
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000673225X00000X
225XH1200X
WAMA60016860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8446353Medicaid
201618OtherL I
WA8446353Medicaid