Provider Demographics
NPI:1679184725
Name:HATCH, CHESNEY CHELLISE (OTD)
Entity type:Individual
Prefix:
First Name:CHESNEY
Middle Name:CHELLISE
Last Name:HATCH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 NM HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9776
Mailing Address - Country:US
Mailing Address - Phone:575-607-6586
Mailing Address - Fax:
Practice Address - Street 1:1500 CAMEO ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5476
Practice Address - Country:US
Practice Address - Phone:575-607-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT-2024-0102225X00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician