Healthcare Provider Details

I. General information

NPI: 1831683721
Provider Name (Legal Business Name): HANNAH HAZLY BARBARA HUTCHESON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 E CLARK ST
VERMILLION SD
57069-2307
US

IV. Provider business mailing address

1815 W 18TH ST APT A1
CEDAR FALLS IA
50613-7105
US

V. Phone/Fax

Practice location:
  • Phone: 605-658-5540
  • Fax:
Mailing address:
  • Phone: 641-231-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: