Healthcare Provider Details

I. General information

NPI: 1821233271
Provider Name (Legal Business Name): JEFFERY WADE HATTEN BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WATER ST SUITE B
JACKSON OH
45640-1354
US

IV. Provider business mailing address

311 WATER ST SUITE B
JACKSON OH
45640-1354
US

V. Phone/Fax

Practice location:
  • Phone: 740-288-1081
  • Fax: 740-288-1091
Mailing address:
  • Phone: 740-288-1081
  • Fax: 740-288-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02704
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: