Provider Demographics
NPI:1912997370
Name:HUBBARD, CLINTON (OT, CHT)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:820 S MCCLELLAN ST STE 118
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2446
Practice Address - Country:US
Practice Address - Phone:509-838-7100
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004122225XH1200X, 225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8436883Medicaid
WAAB25145Medicare ID - Type Unspecified