1770541872 NPI number — MS. KATHY LAURIE HATA OTR/L, LMP

Table of content: MS. KATHY LAURIE HATA OTR/L, LMP (NPI 1770541872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770541872 NPI number — MS. KATHY LAURIE HATA OTR/L, LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATA
Provider First Name:
KATHY
Provider Middle Name:
LAURIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HATA-THOMPSON
Provider Other First Name:
KATHY
Provider Other Middle Name:
LAURIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770541872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98909-0246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-469-4996
Provider Business Mailing Address Fax Number:
509-469-4922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 SOUTH 12TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-469-4996
Provider Business Practice Location Address Fax Number:
509-469-4922
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT00000673 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA60016860 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8446353 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201618 . This is a "L I" identifier . This identifiers is of the category "OTHER".




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