Provider Demographics
NPI:1679902878
Name:HATFIELD, JESSICA KAITLIN LYNN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KAITLIN LYNN
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2605 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1316
Mailing Address - Country:US
Mailing Address - Phone:270-688-8449
Mailing Address - Fax:270-240-4840
Practice Address - Street 1:2605 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1316
Practice Address - Country:US
Practice Address - Phone:270-688-8449
Practice Address - Fax:270-240-4840
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY132289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100270910Medicaid