Healthcare Provider Details

I. General information

NPI: 1598827545
Provider Name (Legal Business Name): JILL HATHAWAY HAYES M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL HATHAWAY BOURNS M.A., A.T.R.

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 BROWNS LN
LOUISVILLE KY
40207-4608
US

IV. Provider business mailing address

1405 BROWNS LN
LOUISVILLE KY
40207-4608
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-0495
  • Fax:
Mailing address:
  • Phone: 502-896-0495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: