MEDICARE: CLINTON HUBBARD OT, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	OT00004122	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912997370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON HUBBARD OT, CHT

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S MCCLELLAN ST STE 118
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99204-2446
Country	:	US
Telephone Number	:	509-838-7100
Fax Number	:	509-227-7070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	01/09/2023

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