Healthcare Provider Details

I. General information

NPI: 1285293035
Provider Name (Legal Business Name): SKYE GREGORY-HATCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date: 07/06/2023
Reactivation Date: 08/02/2023

III. Provider practice location address

105 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-5131
US

IV. Provider business mailing address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5326
US

V. Phone/Fax

Practice location:
  • Phone: 207-577-3310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAP3961
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: