Healthcare Provider Details

I. General information

NPI: 1063510899
Provider Name (Legal Business Name): EMILY HATHAWAY M.S.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 NW 122ND ST
OKLAHOMA CITY OK
73142-3903
US

IV. Provider business mailing address

6905 NW 122ND ST
OKLAHOMA CITY OK
73142-3903
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-6622
  • Fax:
Mailing address:
  • Phone: 405-603-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: